Claim total
$1,768.94
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-12-17
- Stop
- 2020-12-17
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Ursula Nolan
- Payer
- payer Humana
Record id
034c4f48-8c73-4f35-1570-29d4bd4f85c4