Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-11-01
- Stop
- 2014-11-02
The parties
- Patient
- patient Corrina Leontine Smith
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
03b48c3f-9d97-2f75-710a-05f69e75b490