Claim total
$772.84
base $93.83 · payer covered $772.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-10-01
- Stop
- 2018-10-01
The parties
- Patient
- patient Gennie Morgan Olson
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
11f75ca9-f553-2c40-d1f3-c8cefae26a5d