Claim total
$1,235.21
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-12-18
- Stop
- 2025-12-18
The parties
- Patient
- patient Kenia Elida Terry
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
09a3167a-b9be-61ba-72a8-21ce87c95e19