Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-12-04
- Stop
- 2016-12-04
The parties
- Patient
- patient Jon Lavern Baumbach
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
033f4a7e-c2bc-1f12-7d14-a10f95202113