Claim total
$780.15
base $93.83 · payer covered $437.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-11-26
- Stop
- 2007-11-26
The parties
- Patient
- patient Kallie Jordan Sporer
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicare
Record id
0a66253b-4906-0aa6-9992-052860af171e