Claim total
$777.13
base $93.83 · payer covered $677.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2025-05-17
- Stop
- 2025-05-17
The parties
- Patient
- patient Shalon Arnetta Bosco
- Provider
- provider Trent Kozey
- Payer
- payer Medicaid
Record id
03f768f4-038d-f7fd-fab4-3498fcfd03d1