Claim total
$1,510.32
base $93.83 · payer covered $1,410.32
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2007-12-01
- Stop
- 2007-12-01
The parties
- Patient
- patient Stacey Yaeko Bauch
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
12ae0a60-cb75-df45-0c45-699c89d22b82