Claim total
$1,112.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-12-04
- Stop
- 2013-12-04
The parties
- Patient
- patient Gerda Leslie Hagenes
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer UnitedHealthcare
Record id
21879068-ff65-6943-9eff-29a8d17bbc55