Claim total
$903.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-04-12
- Stop
- 1994-04-12
The parties
- Patient
- patient Selene Dona Okuneva
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer No insurance
Record id
1922bd27-5aa8-1926-f56c-d41ecf1db3db