Claim total
$781.37
base $93.83 · payer covered $781.37
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-04-05
- Stop
- 2024-04-05
The parties
- Patient
- patient Wilson Teodoro Kihn
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
04540647-5ff4-de4a-5b25-6549f0edff5f