Claim total
$14,919.96
base $93.83 · payer covered $14,919.96
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-09-06
- Stop
- 2025-09-06
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Dual Eligible
Record id
00decd7e-554a-447f-bdbc-b6d3e9b627f2