Claim total
$911.00
base $93.83 · payer covered $811.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-07-20
- Stop
- 2021-07-20
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-fffd-5e11d799f1cd