Claim total
$1,103.42
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-03-07
- Stop
- 2005-03-07
The parties
- Patient
- patient Regine Hayley Hirthe
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
38ba432b-b122-8312-fd1b-f224a21937a5