Claim total
$775.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1986-07-18
- Stop
- 1986-07-18
The parties
- Patient
- patient Raye Suzy Gusikowski
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Humana
Record id
02c06e54-48b8-2b73-93ab-3f04fa437830