Claim total
$1,178.99
base $93.83 · payer covered $760.68
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-09-27
- Stop
- 1978-09-27
The parties
- Patient
- patient Trevor Darrick Legros
- Provider
- provider Simon Tremblay
- Payer
- payer Medicare
Record id
216fad95-7533-5170-9ced-96401ea67957