Claim total
$3,908.05
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-10-13
- Stop
- 2017-10-13
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-fd86-4b2c83c7e46a