Claim total
$1,276.65
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2012-06-17
- Stop
- 2012-06-17
The parties
- Patient
- patient Leo Ramon Wolf
- Provider
- provider Simon Tremblay
- Payer
- payer Cigna Health
Record id
0132d8d5-6e6e-d90f-05a7-8cbb03909151