Claim total
$1,872.90
base $93.83 · payer covered $1,318.09
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-11-01
- Stop
- 2012-11-01
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Tangela Koelpin
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-df6a-cf94260f76c9