Claim total
$2,081.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-09-17
- Stop
- 2009-09-17
The parties
- Patient
- patient Isadora Madonna Koss
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
2322b960-beaf-9bb3-86c0-89e7cd138090