Claim total
$979.43
base $93.83 · payer covered $979.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-05-25
- Stop
- 2020-05-25
The parties
- Patient
- patient Moira Lili Renner
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
0fc374c8-1e98-440b-7faf-b83e9451b061