Claim total
$979.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-08-26
- Stop
- 2010-08-26
The parties
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
06014704-4726-adb5-eb82-2c255de109bf