Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2026-03-25
- Stop
- 2026-03-26
The parties
- Patient
- patient Tamesha Lecia Wyman
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Dual Eligible
Record id
391bc040-899c-a7be-41ac-fcdc7f83336e