Claim total
$1,178.99
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-09-22
- Stop
- 2005-09-22
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Rodrick Moen
- Payer
- payer Humana
Record id
034c4f48-8c73-4f35-b54d-47e0b0d5c3f6