Claim total
$772.84
base $93.83 · payer covered $672.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2012-01-02
- Stop
- 2012-01-02
The parties
- Patient
- patient Jarod Clyde Sipes
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
32122cd6-5f93-fb84-4c8d-83abd6dbc895