Claim total
$1,264.04
base $93.83 · payer covered $1,011.22
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-08-21
- Stop
- 1994-08-21
The parties
- Patient
- patient Samuel Tomi Luettgen
- Provider
- provider Mike Monahan
- Care site
- care site THE FAMILY PARTNERSHIP
- Payer
- payer Medicare
Record id
2c68c985-bcbe-7914-a2b7-78754aa2bd9a