Claim total
$1,463.73
base $93.83 · payer covered $1,313.73
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1978-06-04
- Stop
- 1978-06-04
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-18a6-fdcbd928ff31