Claim total
$846.78
base $93.83 · payer covered $746.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-11-23
- Stop
- 2024-11-23
The parties
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-716f-32185e2bd9f2