Claim total
$1,248.36
base $93.83 · payer covered $1,198.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-02-26
- Stop
- 1992-02-26
The parties
- Patient
- patient Una Carmelita Douglas
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
391dd5d2-a7de-4280-947f-cfbca8699438