Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-05-13
- Stop
- 2018-05-13
The parties
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Medicaid
Record id
014b9cfb-a71a-d032-6620-93cb7b3d3be7