Claim total
$641.13
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-04-12
- Stop
- 2024-04-12
The parties
- Patient
- patient Agnus Jaskolski
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Humana
Record id
00bd0ed6-396a-5390-e47b-db0d06b210ea