Claim total
$1,003.06
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1982-04-18
- Stop
- 1982-04-18
The parties
- Patient
- patient Kristofer Jordan Bruen
- Provider
- provider Latia Lemke
- Care site
- care site NEIGHBORHOOD HEALTHSOURCE
- Payer
- payer No insurance
Record id
2aad9e33-b123-2099-de76-5b32e019ca5c