Claim total
$2,623.46
base $155.66 · payer covered $2,098.77
The visit
- Class
- Ambulatory
- Code
- 36228007
- Reason
- —
- Start
- 2015-03-09
- Stop
- 2015-03-09
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-c10e-f72308e65603