Claim total
$1,327.00
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-11-01
- Stop
- 1983-11-01
The parties
- Patient
- patient Granville Floyd Moen
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
0cda5c72-868f-0a4b-788a-2afddce10d46