Claim total
$711.72
base $93.83 · payer covered $711.72
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-13
- Stop
- 2016-10-13
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Simon Tremblay
- Payer
- payer Dual Eligible
Record id
050746ba-be7e-c592-4974-00808db9479f