Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-06-25
- Stop
- 1983-06-25
The parties
- Patient
- patient Eileen Nicolette Blanda
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer No insurance
Record id
1e15063e-b453-6e17-52f2-ed0156801dad