Claim total
$704.41
base $93.83 · payer covered $604.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-09-04
- Stop
- 2015-09-04
The parties
- Patient
- patient Shanelle Neomi Labadie
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2d4a29d8-843f-44db-3fc9-10d75eb826c7