Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-08-02
- Stop
- 1991-08-02
The parties
- Patient
- patient Ja Lori Gottlieb
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
39a9f648-9e90-e24a-3e57-b60ce5e590ca