Claim total
$1,183.00
base $93.83 · payer covered $1,110.02
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-06-13
- Stop
- 2026-06-13
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-dfc8-c54ba15f5640