Claim total
$840.41
base $93.83 · payer covered $740.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-02-02
- Stop
- 2017-02-02
The parties
- Patient
- patient Santo Lucas Stracke
- Provider
- provider Celsa Bailey
- Care site
- care site INDEPENDENT MEDICAL CLINIC PA
- Payer
- payer Medicaid
Record id
39fd323a-3e7b-6551-9000-0126c83c3e54