Claim total
$979.48
base $93.83 · payer covered $783.58
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2020-11-06
- Stop
- 2020-11-06
The parties
- Patient
- patient Winfred Otha Quitzon
- Provider
- provider Long Konopelski
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer UnitedHealthcare
Record id
038b62bd-a0b5-4b7e-415a-da075a304f58