Claim total
$711.72
base $93.83 · payer covered $316.35
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-12-12
- Stop
- 2015-12-12
The parties
- Patient
- patient Amanda Kelsey Daugherty
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Anthem
Record id
00a2ce2f-1e05-ab20-8524-06b9b6940cf8