Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-05-23
- Stop
- 2021-05-23
The parties
- Patient
- patient Penny Shona Schaden
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Humana
Record id
03e70281-0fa0-c7c6-5120-1e746a4b0659