Claim total
$1,463.73
base $93.83 · payer covered $1,363.73
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2022-05-21
- Stop
- 2022-05-21
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-bf55-0b546b3d22b2