Claim total
$1,280.55
base $93.83 · payer covered $1,130.55
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1982-11-11
- Stop
- 1982-11-11
The parties
- Patient
- patient Mitchell Rolf Jakubowski
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
08eeddd3-8f5c-777d-0f86-642f7ae0fae4