Claim total
$2,026.26
base $93.83 · payer covered $1,620.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-11-07
- Stop
- 2013-11-07
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Ursula Nolan
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-137d-2a015a0600b5