Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-02-10
- Stop
- 2013-02-10
The parties
- Patient
- patient Marina Jacque Carter
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2d76e265-c083-ae5f-19e1-6fa2481375c1