Claim total
$836.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1990-08-17
- Stop
- 1990-08-17
The parties
- Patient
- patient Imelda Tamar Moen
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
2c08bece-c801-e6f0-68fa-f9c76dcc744a