Claim total
$1,108.12
base $93.83 · payer covered $1,008.12
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-01-12
- Stop
- 2022-01-12
The parties
- Patient
- patient Larraine Zita Robel
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
2df46b25-4cd4-6fa2-15fb-c740f27f6f2b