Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-07
- Stop
- 2016-10-07
The parties
- Patient
- patient Loma Tawanna Ferry
- Provider
- provider Simon Tremblay
- Payer
- payer No insurance
Record id
04384da7-7311-e99a-c7b5-78ea37764b3e