Claim total
$767.69
base $93.83 · payer covered $617.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1996-04-18
- Stop
- 1996-04-18
The parties
- Patient
- patient Bambi Adah Koss
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Medicaid
Record id
2d0c65c4-941d-c58c-73d4-47b009ed701b