Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-07-24
- Stop
- 2022-07-24
The parties
- Patient
- patient Vernon Lonny Block
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer No insurance
Record id
0aa3f498-3892-c442-c99b-ccb1b1437902