Claim total
$972.12
base $93.83 · payer covered $872.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-09-24
- Stop
- 2022-09-24
The parties
- Patient
- patient Rafael Clair Schmitt
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0d7dc81d-1ed8-7260-1b9c-58d95abea0e4