Claim total
$775.00
base $93.83 · payer covered $619.99
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-10-01
- Stop
- 2016-10-01
The parties
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicare
Record id
018a1080-c6e3-9b93-21f1-0b4dce57e23f