Claim total
$1,093.13
base $93.83 · payer covered $1,093.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1964-08-28
- Stop
- 1964-08-28
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-36b4-cd6f4318a350