Claim total
$704.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-04-07
- Stop
- 2013-04-07
The parties
- Patient
- patient Penny Shona Schaden
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Humana
Record id
03e70281-0fa0-c7c6-7a0a-32f70857ae12