Claim total
$13,623.60
base $93.83 · payer covered $10,898.87
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-11-28
- Stop
- 2025-11-28
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Simon Tremblay
- Payer
- payer Medicare
Record id
04384da7-7311-e99a-b90f-ab9e25d46959