Claim total
$1,653.57
base $93.83 · payer covered $1,603.57
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2004-12-04
- Stop
- 2004-12-04
The parties
- Patient
- patient Bradford Bennie Klein
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
01bbe7d1-151b-3eec-2f7f-11930b38d102