Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1994-10-10
- Stop
- 1994-10-10
The parties
- Patient
- patient Brendon Marcos Sanford
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
032ec4eb-84a5-3e3f-f2ff-5222932b7dd1