Claim total
$1,397.71
base $93.83 · payer covered $1,297.71
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-05-15
- Stop
- 2021-05-15
The parties
- Patient
- patient Belva Nadene Kuphal
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
0430ce7c-cb64-da75-4541-cfd412d7cffa