Claim total
$899.40
base $93.83 · payer covered $749.40
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1990-05-01
- Stop
- 1990-05-01
The parties
- Patient
- patient Julio Leslie Kub
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
380e310b-3f6b-f03c-87c1-6b0494908890