Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2010-04-29
- Stop
- 2010-04-29
The parties
- Patient
- patient Allen Trent Mann
- Provider
- provider Simon Tremblay
- Payer
- payer Humana
Record id
007bcc47-8ca5-7eab-f88f-9a981b7872aa