Claim total
$775.00
base $93.83 · payer covered $675.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-07-17
- Stop
- 2024-07-17
The parties
- Provider
- provider Samuel Boyle
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-2f38-0230e8e66932