Claim total
$1,314.61
base $93.83 · payer covered $1,164.61
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-05-17
- Stop
- 2005-05-17
The parties
- Patient
- patient Amy Irena Jacobi
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
0c24ce21-5059-79dc-de47-af57d4a4afeb