Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1979-09-11
- Stop
- 1979-09-11
The parties
- Patient
- patient Ty Orville Zemlak
- Provider
- provider Garret Mohr
- Care site
- care site NORTH MEMORIAL HEALTH CARE
- Payer
- payer UnitedHealthcare
Record id
321c72ca-8c08-fd89-e3fe-e5a57ade96b0