Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-08-18
- Stop
- 2020-08-18
The parties
- Patient
- patient Raul Dooley
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
2dcc7333-1d20-9674-9297-0d9089ddb361