Claim total
$1,001.06
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1980-11-21
- Stop
- 1980-11-21
The parties
- Patient
- patient Ramonita Padberg
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
32bc176d-7d6d-f87b-4941-664c51036b21