Claim total
$1,535.26
base $93.83 · payer covered $1,228.20
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-12-29
- Stop
- 2022-12-29
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-2141-bbc13dd582f4