Claim total
$1,412.12
base $93.83 · payer covered $1,312.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-10-15
- Stop
- 2009-10-15
The parties
- Patient
- patient Dusti Carmen Cremin
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0fb29067-0b92-84ae-e2b4-9aa6313cf9a2