Claim total
$1,021.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-04-17
- Stop
- 1999-04-17
The parties
- Patient
- patient Ty Kenny Quitzon
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
32587289-9da4-0bd5-be75-dc91e803ef65