Claim total
$1,036.62
base $93.83 · payer covered $1,036.62
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-04-26
- Stop
- 2019-04-26
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Simon Tremblay
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-ffe6-83d55e69ccae