Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-10-08
- Stop
- 2015-10-08
The parties
- Patient
- patient Lamar Mark Connelly
- Provider
- provider Julene Lemke
- Payer
- payer Dual Eligible
Record id
050746ba-be7e-c592-2df5-969b756d53bf