Claim total
$979.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-04-19
- Stop
- 2000-04-19
The parties
- Patient
- patient Luisa Adriana Candelaria
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
30a17686-cce3-be65-45c9-9d0095a3a1cc