Claim total
$1,384.64
base $93.83 · payer covered $926.38
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-11-13
- Stop
- 2014-11-13
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Ursula Nolan
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-6939-f3db641ba31a