Claim total
$719.03
base $93.83 · payer covered $719.03
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-08-11
- Stop
- 2013-08-11
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-dcfc-5b71bdff1c2b