Claim total
$979.43
base $93.83 · payer covered $783.53
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-22
- Stop
- 2016-10-23
The parties
- Patient
- patient Tamara Dorla Weimann
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
3a5e2ef0-e9eb-245d-afa2-712390578d1c