Claim total
$1,051.93
base $93.83 · payer covered $901.93
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-05-31
- Stop
- 1987-05-31
The parties
- Patient
- patient Stacy Herzog
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
070c7867-fbf2-7941-915b-feac24b52aa2