Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-12-12
- Stop
- 1978-12-12
The parties
- Patient
- patient Forrest Heath Bailey
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
3595a261-a367-4bc4-2f6a-503759d61c5d