Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-05-23
- Stop
- 1981-05-23
The parties
- Patient
- patient Errol Delmar Lockman
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer No insurance
Record id
09a2ab02-bbcf-9b47-187b-bd39af5886f5