Claim total
$906.71
base $93.83 · payer covered $4.26
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-03-11
- Stop
- 2015-03-11
The parties
- Patient
- patient Mariann Tennie Dooley
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Anthem
Record id
1b992c53-6e6f-6996-a354-7dd39bc55c1f