Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-01-25
- Stop
- 2017-01-25
The parties
- Patient
- patient Ángela Carlota Lovato
- Provider
- provider Simon Tremblay
- Payer
- payer Dual Eligible
Record id
0465c17f-66cb-2155-d85a-017ddc2dca47