Claim total
$1,733.70
base $93.83 · payer covered $1,207.75
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-10-15
- Stop
- 2009-10-15
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Elbert Schaefer
- Payer
- payer Medicare
Record id
034c4f48-8c73-4f35-e32a-a14fbba5f240