Claim total
$1,108.12
base $93.83 · payer covered $958.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2000-11-14
- Stop
- 2000-11-14
The parties
- Patient
- patient Dione Ernser
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
0bf6e6c4-0773-250a-b25d-9f7ee9c3aa4c