Claim total
$777.13
base $93.83 · payer covered $777.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-05-14
- Stop
- 2021-05-14
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-287e-f99f267659fd