Claim total
$1,590.29
base $93.83 · payer covered $1,440.29
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1961-06-05
- Stop
- 1961-06-05
The parties
- Patient
- patient Zachery Keenan Berge
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer Medicaid
Record id
29247b3f-f26a-3ab7-c25b-a1c43d230a37