Claim total
$681.44
base $93.83 · payer covered $681.44
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2019-11-07
- Stop
- 2019-11-07
The parties
- Patient
- patient Terese Darla Williamson
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
0098424c-ec2c-0924-b8d4-131851918a59