Claim total
$1,109.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-04-13
- Stop
- 2005-04-13
The parties
- Patient
- patient Carlyn Donita Ortiz
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
00e3929f-91f8-0715-f73d-0048976d4f62