Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-06-15
- Stop
- 1991-06-15
The parties
- Patient
- patient Deandre Dylan Wisozk
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
198037c0-3402-fbe3-2230-ed6c8e634053