Claim total
$1,074.07
base $93.83 · payer covered $924.07
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2005-11-02
- Stop
- 2005-11-02
The parties
- Patient
- patient Laverne Stanley Osinski
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
1b725f0a-4f9d-132d-facc-74a34c9f23d5