Claim total
$1,049.23
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-07-17
- Stop
- 1971-07-17
The parties
- Patient
- patient Porfirio West
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
05880a71-6004-727f-2805-a625bd045229