Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2016-10-05
- Stop
- 2016-10-05
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-e369-723393fe3472