Claim total
$1,064.22
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-09-21
- Stop
- 2024-09-21
The parties
- Patient
- patient Lizette Ardella Dicki
- Provider
- provider Roslyn Reichel
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
31c17b80-43b3-1002-6518-1a62dd8c2094