Claim total
$631.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-09-21
- Stop
- 1991-09-21
The parties
- Patient
- patient Bradford Bennie Klein
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
01bbe7d1-151b-3eec-ad02-104b538eb9e2