Claim total
$911.00
base $93.83 · payer covered $911.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-09-15
- Stop
- 2019-09-15
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Avery VonRueden
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-1222-f48d3f62e8fb