Claim total
$1,252.65
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-12-22
- Stop
- 1999-12-22
The parties
- Patient
- patient Una Carmelita Douglas
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
391dd5d2-a7de-4280-eb3d-e98cb8370989