Claim total
$843.43
base $93.83 · payer covered $743.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-08-16
- Stop
- 2022-08-16
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-4b0a-1382985c70f0