Claim total
$773.83
base $93.83 · payer covered $673.83
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-04-01
- Stop
- 2018-04-01
The parties
- Patient
- patient Ines Jose Greenfelder
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
025967b2-09e2-065d-d4c2-3838f3ab90b3