Claim total
$1,378.27
base $93.83 · payer covered $1,102.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-01-04
- Stop
- 2024-01-04
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-663f-bf0cbb1135c3