Claim total
$291.66
base $155.66 · payer covered $0.00
The visit
- Class
- Outpatient
- Code
- 33879002
- Reason
- —
- Start
- 2021-05-06
- Stop
- 2021-05-06
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Humana
Record id
034c4f48-8c73-4f35-d7bb-09b3d3ffe4d8