Claim total
$644.15
base $93.83 · payer covered $544.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-01-17
- Stop
- 2012-01-17
The parties
- Patient
- patient Warren Marlon Sauer
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
14311efe-7553-1f52-5240-5794eab01d0c