Claim total
$704.41
base $93.83 · payer covered $704.41
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2026-01-04
- Stop
- 2026-01-04
The parties
- Provider
- provider Vanda Lebsack
- Care site
- care site MORNINGSIDE FAMILY PHYSICIANS
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-cdd1-7f4eda8b7dd3