Claim total
$1,479.99
base $93.83 · payer covered $1,183.98
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-12-23
- Stop
- 2021-12-23
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Rodrick Moen
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-6040-806ecb0db2c6