Claim total
$1,058.16
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-03-20
- Stop
- 2014-03-20
The parties
- Patient
- patient Agueda Raelene Dibbert
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
Record id
2c2a55c2-b04c-0ce4-5e49-18160cba2a92