Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Outpatient
- Code
- 185349003
- Reason
- —
- Start
- 2025-07-13
- Stop
- 2025-07-13
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Jonas Pouros
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-625d-8fb2c46e0f91