Claim total
$1,093.89
base $93.83 · payer covered $1,093.89
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-08-05
- Stop
- 2020-08-05
The parties
- Patient
- patient Ramon Josef Hagenes
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Dual Eligible
Record id
358aeebf-9459-7875-ea61-8f93f2baf241