Claim total
$985.80
base $93.83 · payer covered $835.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-02-13
- Stop
- 2004-02-13
The parties
- Patient
- patient Rory Jinny Ankunding
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0fedc868-ae30-8408-04bb-a8b379dbadeb