Claim total
$1,246.63
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-06-30
- Stop
- 2011-06-30
The parties
- Patient
- patient Shira Violet Bartoletti
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer No insurance
Record id
168887d4-cfa7-87ad-be6e-fb6e1efd58ca