Claim total
$913.13
base $93.83 · payer covered $813.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-08-10
- Stop
- 2021-08-10
The parties
- Patient
- patient Bettina Kira Schiller
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0d6a874a-279a-257b-3aef-819cd99c22da