Claim total
$1,597.60
base $93.83 · payer covered $1,497.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-06-26
- Stop
- 2016-06-26
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-f742-3b451129be01