Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-11-14
- Stop
- 2012-11-14
The parties
- Patient
- patient Annamarie Gretta Wolff
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
109b1845-597b-4626-c509-0f282c4a0f78