Claim total
$985.80
base $93.83 · payer covered $885.80
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2009-03-31
- Stop
- 2009-04-01
The parties
- Patient
- patient Verlie Julie Ullrich
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
35500c96-6b2b-970e-07c4-58855e9c1b1d