Claim total
$843.43
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-04-27
- Stop
- 2026-04-27
The parties
- Patient
- patient Gwenn Xochitl Pollich
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Humana
Record id
36bd080b-6e6b-6abc-f361-27aab3ea750a