Claim total
$846.78
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-05-01
- Stop
- 2007-05-01
The parties
- Patient
- patient Virginia Ramona Rosales
- Provider
- provider Richard Carter
- Care site
- care site SAMA HEALTH CARE
- Payer
- payer UnitedHealthcare
Record id
0fc0e1a1-6c95-9fb6-ac35-3e9581a15b6a