Claim total
$13,489.73
base $93.83 · payer covered $13,489.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-06-06
- Stop
- 2015-06-06
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Albert Blanda
- Care site
- care site WEST METRO WELLNESS PC
- Payer
- payer Medicaid
Record id
00decd7e-554a-447f-d69d-617a61852baa