Claim total
$1,273.16
base $93.83 · payer covered $1,273.16
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-05-01
- Stop
- 2020-05-01
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-db0e-d9a5d768b3e8