Claim total
$775.00
base $93.83 · payer covered $775.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-09-29
- Stop
- 2015-09-29
The parties
- Patient
- patient Annamarie Mollie Hoppe
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
0555f11c-c453-57eb-0fbc-57e2ab1fcd59