Claim total
$1,570.66
base $93.83 · payer covered $90.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-11-16
- Stop
- 2011-11-16
The parties
- Patient
- patient Enrique Kautzer
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Anthem
Record id
36fced78-f023-679f-35ab-df89f860b978