Claim total
$830.97
base $93.83 · payer covered $830.97
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-03-18
- Stop
- 2026-03-18
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Simon Tremblay
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-3139-db0549b5e490