Claim total
$979.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-09-08
- Stop
- 2016-09-08
The parties
- Patient
- patient Barton Jeffry Pacocha
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
23a9af95-b665-07b1-94b0-d8ff9014f313