Claim total
$1,416.74
base $93.83 · payer covered $1,416.74
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2017-10-01
- Stop
- 2017-10-01
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-7234-4849b7dab4c3