Claim total
$1,122.90
base $93.83 · payer covered $1,122.90
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-05-28
- Stop
- 2007-05-28
The parties
- Patient
- patient Salome Kanisha D'Amore
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
204f81a9-88e4-4fbf-5a99-bb954d021d69