Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-09-26
- Stop
- 1996-09-26
The parties
- Patient
- patient Lynda Carissa Wiza
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
11b58047-9562-e585-54cd-0c59e7f8af62