Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-09-26
- Stop
- 2021-09-26
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer Medicaid
Record id
03478e49-59cf-7140-fe05-0f1c8613487b