Claim total
$763.35
base $93.83 · payer covered $613.35
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2000-04-15
- Stop
- 2000-04-15
The parties
- Patient
- patient Sacha Sharita Hodkiewicz
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
3428133e-e709-f6fe-918d-6cbc9cc7b38e