Claim total
$1,116.65
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-11-25
- Stop
- 2020-11-25
The parties
- Patient
- patient Enrique Kautzer
- Provider
- provider Kristofer Hettinger
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Aetna
Record id
36fced78-f023-679f-61e1-153e68ca091a