Claim total
$1,178.99
base $93.83 · payer covered $1,178.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-05-07
- Stop
- 2016-05-07
The parties
- Patient
- patient Rafael Jacob Stark
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
317ac6ea-e6de-31fb-dac3-dd4f7c4c630e