Claim total
$662.49
base $93.83 · payer covered $562.49
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2015-05-27
- Stop
- 2015-05-27
The parties
- Patient
- patient Dahlia Taren Roberts
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
21cb4452-b958-9992-4046-42f6d57fe3c7