Claim total
$505.13
base $93.83 · payer covered $355.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-09-28
- Stop
- 2005-09-28
The parties
- Patient
- patient Sha Robin Reilly
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
043d6e13-0cc7-07f3-2df5-51c664f1d34d