Claim total
$773.83
base $93.83 · payer covered $773.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-02-12
- Stop
- 2017-02-12
The parties
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-2877-60ee5388bb1b