Claim total
$910.06
base $93.83 · payer covered $910.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-09-20
- Stop
- 2020-09-20
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-7140-132e-1e740a56956f