Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-12-27
- Stop
- 2012-12-27
The parties
- Patient
- patient Isaiah Lesch
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
30fd7e10-dfb5-c4bb-ec64-2a2f1acaba9a