Claim total
$711.72
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-04-15
- Stop
- 2007-04-15
The parties
- Patient
- patient Zita Sharita Baumbach
- Provider
- provider Simon Tremblay
- Payer
- payer Aetna
Record id
15e93d16-025d-6783-da28-b36fa6657836