Claim total
$772.84
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-11-10
- Stop
- 1964-11-10
The parties
- Patient
- patient Ty Orville Zemlak
- Provider
- provider Altagracia Rippin
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer UnitedHealthcare
Record id
321c72ca-8c08-fd89-0c24-dd49fd0bfe85