Claim total
$838.28
base $93.83 · payer covered $688.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1977-11-30
- Stop
- 1977-11-30
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
0465c17f-66cb-2155-475a-06ed5260b0dd