Claim total
$1,590.29
base $93.83 · payer covered $1,440.29
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1998-08-28
- Stop
- 1998-08-28
The parties
- Patient
- patient Vito Glenn Medhurst
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
26ddb759-380a-cffb-3474-3afe4a24afa8