Claim total
$758.25
base $93.83 · payer covered $708.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-07-22
- Stop
- 1977-07-22
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-6d66-5a37fef87ba9