Claim total
$974.28
base $93.83 · payer covered $974.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-10-13
- Stop
- 2024-10-13
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Dual Eligible
Record id
03478e49-59cf-7140-1b15-c223e5817dac