Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1979-11-01
- Stop
- 1979-11-01
The parties
- Patient
- patient Simon Frederic Gulgowski
- Provider
- provider Tangela Koelpin
- Payer
- payer UnitedHealthcare
Record id
034c4f48-8c73-4f35-ea18-598a9bc6fad0