Claim total
$505.13
base $93.83 · payer covered $455.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1989-04-07
- Stop
- 1989-04-07
The parties
- Patient
- patient Shanelle Neomi Labadie
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2d4a29d8-843f-44db-20c3-b1fda967026e