Claim total
$1,486.58
base $93.83 · payer covered $1,436.58
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2003-12-13
- Stop
- 2003-12-13
The parties
- Patient
- patient Demetrius Kellye Brown
- Provider
- provider Julene Lemke
- Payer
- payer Medicaid
Record id
34d00a16-aef5-c007-f852-bb4d5c342684