Claim total
$840.41
base $93.83 · payer covered $690.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1989-12-27
- Stop
- 1989-12-27
The parties
- Patient
- patient Sidney Champlin
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
33cb6c8c-a991-8f91-2081-4f72c817b423