Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2022-04-30
- Stop
- 2022-04-30
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-610f-69dcf5f9a172