Claim total
$772.84
base $93.83 · payer covered $622.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1985-05-04
- Stop
- 1985-05-04
The parties
- Patient
- patient Matt Nitzsche
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
11bc85b9-5a20-dc01-c18d-4d0438e60145