Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-04-27
- Stop
- 1975-04-27
The parties
- Patient
- patient Penny Shona Schaden
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer No insurance
Record id
03e70281-0fa0-c7c6-c0af-937d713d0c12