Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-07-14
- Stop
- 2018-07-14
The parties
- Patient
- patient Spencer Olen Fay
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer No insurance
Record id
127cedd0-f1be-4cc1-0741-9832c21eaa11