Claim total
$843.43
base $93.83 · payer covered $693.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-10-01
- Stop
- 1971-10-02
The parties
- Patient
- patient Erika Predovic
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
1a9016a2-45a9-4f54-9b4d-6ea9077cda00