Claim total
$1,123.78
base $93.83 · payer covered $1,023.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-03-10
- Stop
- 2025-03-10
The parties
- Patient
- patient Hertha Conception Von
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
0d4ddbb6-9f39-9726-ddf7-4df453bbb9ec