Claim total
$1,183.38
base $93.83 · payer covered $1,183.38
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-04-11
- Stop
- 2023-04-11
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Simon Tremblay
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-c1bc-e5c8b499232f