Claim total
$997.56
base $93.83 · payer covered $897.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-06-01
- Stop
- 2024-06-01
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-df8e-98c2abb77291