Claim total
$979.43
base $93.83 · payer covered $829.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-08-29
- Stop
- 1987-08-29
The parties
- Patient
- patient Spencer Olen Fay
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
127cedd0-f1be-4cc1-7d5c-7608412cc057