Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2021-12-12
- Stop
- 2021-12-12
The parties
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-b168-71cd661138b9