Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-11-13
- Stop
- 1981-11-13
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-93f1-bb6635010646