Claim total
$1,112.41
base $93.83 · payer covered $778.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-09-05
- Stop
- 2014-09-05
The parties
- Patient
- patient Edythe Nga Pacocha
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
Record id
00cb11fd-f3f7-0950-3895-72bf8f3aa238