Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-01-02
- Stop
- 1999-01-02
The parties
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-e000-fdb98a1f006e