Claim total
$767.69
base $93.83 · payer covered $614.14
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-03-28
- Stop
- 2021-03-28
The parties
- Patient
- patient Delphia Ilse Altenwerth
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
1442b902-3b39-ca20-3013-c460cb9f86f7