Claim total
$1,463.73
base $93.83 · payer covered $4.58
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1975-10-23
- Stop
- 1975-10-23
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Rodrick Moen
- Payer
- payer UnitedHealthcare
Record id
034c4f48-8c73-4f35-56c5-ea72fc87971c