Claim total
$93.41
base $93.39 · payer covered $74.73
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2015-12-10
- Stop
- 2015-12-10
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-f1c6-a546a181ac97