Claim total
$644.15
base $93.83 · payer covered $494.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-10-02
- Stop
- 1997-10-02
The parties
- Patient
- patient Dusti Carmen Cremin
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0fb29067-0b92-84ae-e576-76f12e9c0318