Claim total
$1,527.01
base $93.83 · payer covered $206.32
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1985-07-12
- Stop
- 1985-07-12
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-7114-383b8ecb7a05