Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-10-16
- Stop
- 2025-10-16
The parties
- Patient
- patient Johnnie Rashad Pfeffer
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
030fbd6c-bbe4-c142-e77b-072c7b6d9952