Claim total
$1,457.36
base $93.83 · payer covered $982.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-06-29
- Stop
- 2007-06-29
The parties
- Patient
- patient Jerald Stephan Franecki
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
14d5e8cb-a3c4-0491-00df-a8ed4408c0b4