Claim total
$1,175.86
base $93.83 · payer covered $1,075.86
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-10-31
- Stop
- 2015-10-31
The parties
- Patient
- patient Lanny Casper
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
2b3be322-b6d7-acfd-46cc-86c20b3249df