Claim total
$1,597.60
base $93.83 · payer covered $1,094.21
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-11-30
- Stop
- 2017-11-30
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Rodrick Moen
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-4347-810dd85e0eb1