Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-07-12
- Stop
- 1987-07-12
The parties
- Patient
- patient Clara Rosalia Cantú
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
0bbd45c6-8916-cb4f-384b-5ecb7582bf10