Claim total
$1,050.04
base $93.83 · payer covered $900.04
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1979-04-05
- Stop
- 1979-04-05
The parties
- Patient
- patient Terrell Allan Walter
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0c1ee120-1dc7-6b68-c527-f46b7ebc8246