Claim total
$1,583.92
base $93.83 · payer covered $1,267.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-12-06
- Stop
- 2018-12-06
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Ursula Nolan
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-1870-13bc6bdf22c5