Claim total
$1,178.99
base $93.83 · payer covered $760.18
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-12-12
- Stop
- 2019-12-12
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-7aad-fc3c5d69212e