Claim total
$1,185.11
base $93.83 · payer covered $1,085.11
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-10-24
- Stop
- 2013-10-24
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-d378-5b07a50aac3e