Claim total
$704.41
base $93.83 · payer covered $704.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-07-12
- Stop
- 2025-07-12
The parties
- Patient
- patient Heriberto Orval Feest
- Provider
- provider Thomasine Balistreri
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer UnitedHealthcare
Record id
04dd6dd9-2faa-05da-90ed-596772d8d094