Claim total
$972.12
base $93.83 · payer covered $972.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-06-23
- Stop
- 2021-06-23
The parties
- Patient
- patient Tyra Na Bosco
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
12999fea-4e2a-27bb-f397-8d5ec6d8d49a