Claim total
$791.34
base $93.83 · payer covered $791.34
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-12-30
- Stop
- 2018-12-30
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-ec20-24a9f4bb1f03