Claim total
$1,049.08
base $93.83 · payer covered $671.17
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-03-22
- Stop
- 2020-03-22
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-ca20-9121-9e82c7dc658f