Claim total
$1,283.39
base $93.83 · payer covered $1,133.39
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-10-16
- Stop
- 1999-10-16
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-df45-2fc9-e8483bdb49f1