Claim total
$972.12
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-10-28
- Stop
- 2006-10-29
The parties
- Patient
- patient Hilton Randal Auer
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
111cd2b1-c486-f225-9808-1fd7fe16b9db