Claim total
$985.80
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-10-07
- Stop
- 2024-10-07
The parties
- Patient
- patient Ka Jacobson
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Anthem
Record id
255c6acb-9d44-0232-0d39-0ee4e38c2731