Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-09-14
- Stop
- 2010-09-14
The parties
- Patient
- patient Agnes Dietrich
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
270ef1b8-bd71-e9bb-d8e6-dbb0f2144437