Claim total
$1,046.06
base $93.83 · payer covered $946.06
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-11-14
- Stop
- 2020-11-14
The parties
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-f600-2f2d715048b3