Claim total
$1,054.85
base $93.83 · payer covered $904.85
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1947-08-04
- Stop
- 1947-08-04
The parties
- Patient
- patient Brian Waldo Hettinger
- Provider
- provider Norris Kertzmann
- Care site
- care site HENNEPIN COUNTY
- Payer
- payer Medicaid
Record id
1f852fca-7569-a697-0dfc-e4be4a5ec6b0