Claim total
$911.00
base $93.83 · payer covered $811.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-10-13
- Stop
- 2025-10-13
The parties
- Patient
- patient Brendon Marcos Sanford
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
032ec4eb-84a5-3e3f-1a35-fd37fec15305