Claim total
$93.49
base $93.39 · payer covered $74.79
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- —
- Start
- 2019-12-26
- Stop
- 2019-12-26
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-95cf-8066eaa47ab7