Claim total
$631.69
base $93.83 · payer covered $631.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-06-20
- Stop
- 2025-06-20
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Julene Lemke
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-8e89-62eb515d6e83