Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-09-19
- Stop
- 2015-09-19
The parties
- Patient
- patient Asa Balistreri
- Provider
- provider Rosann Sipes
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer UnitedHealthcare
Record id
1f720def-1bd4-df8f-aa7d-25d928ff9993