Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-11-24
- Stop
- 2019-11-24
The parties
- Patient
- patient Faustino Romeo Bauch
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
03e24eff-3793-eaeb-deba-34c7389efa82