Claim total
$1,318.06
base $93.83 · payer covered $1,318.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-05-30
- Stop
- 2009-05-30
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
00decd7e-554a-447f-7567-993c433b081f