Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-04-25
- Stop
- 1981-04-25
The parties
- Patient
- patient Roman Sam Kuhic
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
13ad3f28-2867-7f2e-9203-bb732ae8a460