Claim total
$1,426.55
base $93.83 · payer covered $1,276.55
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1969-05-26
- Stop
- 1969-05-26
The parties
- Patient
- patient Brian Waldo Hettinger
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1f852fca-7569-a697-286d-4ab9aa3164e5