Claim total
$838.28
base $93.83 · payer covered $688.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1967-06-23
- Stop
- 1967-06-23
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-4878-2b9c1e921ba7