Claim total
$1,116.65
base $93.83 · payer covered $1,116.65
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-12-02
- Stop
- 2013-12-02
The parties
- Patient
- patient Kallie Jordan Sporer
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Dual Eligible
Record id
0a66253b-4906-0aa6-1b26-e3fe47257f9d