Claim total
$964.84
base $93.83 · payer covered $914.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1973-06-29
- Stop
- 1973-06-29
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-7480-1d70a4e0744a