Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-06-03
- Stop
- 1986-06-03
The parties
- Patient
- patient Catharine Many Nolan
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
03cbffbc-74a2-befb-71d1-83e73eac6f39