Claim total
$1,463.73
base $93.83 · payer covered $1,313.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1991-01-04
- Stop
- 1991-01-04
The parties
- Patient
- patient Agnus Jaskolski
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
00bd0ed6-396a-5390-5f58-8c1cbb0f2083