Claim total
$1,233.06
base $93.83 · payer covered $1,083.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1993-02-06
- Stop
- 1993-02-06
The parties
- Patient
- patient Ayana Karine Shields
- Provider
- provider Todd Marks
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
39583d22-69ce-add7-ab8e-8e5c0e35ddac