Claim total
$1,112.36
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-05-07
- Stop
- 2012-05-07
The parties
- Patient
- patient Matha Wanetta Greenholt
- Provider
- provider Simon Tremblay
- Payer
- payer Aetna
Record id
38475c93-5cdf-8ed5-3c72-2288d0ad0b1b