Claim total
$505.13
base $93.83 · payer covered $505.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2023-12-24
- Stop
- 2023-12-24
The parties
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-4511-ab084eacd353