Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2018-10-17
- Stop
- 2018-10-17
The parties
- Patient
- patient Cecilia Botsford
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
046c8377-6cc1-c8f9-2f39-c1999c7caf9f