Claim total
$1,081.78
base $93.83 · payer covered $931.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1988-06-29
- Stop
- 1988-06-29
The parties
- Patient
- patient Quinton Lueilwitz
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
19beb540-4cdd-68a1-0840-ad72732bad5b