Claim total
$1,352.16
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-01-15
- Stop
- 1994-01-15
The parties
- Patient
- patient Deann Shawnee Hilll
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Humana
Record id
290b32a5-c822-1cc3-8624-b75ea067b3ea