Claim total
$1,361.58
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-09-01
- Stop
- 2006-09-01
The parties
- Patient
- patient Evelyne Minda Denesik
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
0d9d9f81-b2ab-7b08-9361-3265063a4589