Claim total
$906.71
base $93.83 · payer covered $871.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1982-10-24
- Stop
- 1982-10-24
The parties
- Patient
- patient Joanne Carly Casper
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
13782635-8a63-14aa-2125-af1869c4eac1