Claim total
$1,084.79
base $93.83 · payer covered $1,084.79
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-03-15
- Stop
- 2013-03-15
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-10a5-8c7a5656a2fe