Claim total
$775.00
base $93.83 · payer covered $619.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-07-14
- Stop
- 2024-07-14
The parties
- Patient
- patient Terrance Derek Mueller
- Provider
- provider Simon Tremblay
- Payer
- payer UnitedHealthcare
Record id
032e5f12-51a3-9303-b302-b7975526c92c