Claim total
$1,131.34
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-08-09
- Stop
- 2016-08-09
The parties
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Humana
Record id
032df52f-9699-4603-2bd7-73a2a8647f2c