Claim total
$1,617.93
base $93.83 · payer covered $1,617.93
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-04-01
- Stop
- 2017-04-01
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-55c9-a3c13b588d78