Claim total
$1,369.25
base $93.83 · payer covered $1,319.25
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-04-24
- Stop
- 1994-04-24
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Wes Jast
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-07ea-54d0daf98fe9