Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-10-31
- Stop
- 2022-10-31
The parties
- Patient
- patient Augustus Reginald Hintz
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
33e3f82c-8e34-c43b-ed28-3cb9a3532afb