Claim total
$1,177.77
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-11-11
- Stop
- 2025-11-11
The parties
- Patient
- patient Jacquelin Leffler
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Anthem
Record id
1238e43a-68f7-e8e8-fdb2-e4b0c7d66a53