Claim total
$1,052.43
base $93.83 · payer covered $952.43
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2026-01-25
- Stop
- 2026-01-25
The parties
- Patient
- patient Ines Jose Greenfelder
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
025967b2-09e2-065d-50d7-035b8f7018d1