Claim total
$711.72
base $93.83 · payer covered $354.10
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-12-17
- Stop
- 2016-12-17
The parties
- Patient
- patient Amanda Kelsey Daugherty
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Anthem
Record id
00a2ce2f-1e05-ab20-d720-51d583d53b0e