Claim total
$1,186.30
base $93.83 · payer covered $764.19
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2006-09-28
- Stop
- 2006-09-28
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Ursula Nolan
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-a3e7-d20656b91bfd