Claim total
$780.15
base $93.83 · payer covered $630.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-06-19
- Stop
- 1964-06-19
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-0395-4ca7393e9f31