Claim total
$911.00
base $93.83 · payer covered $911.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-10-08
- Stop
- 2023-10-08
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Ines Kautzer
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Dual Eligible
Record id
03478e49-59cf-7140-606d-367943fcb2bb