Claim total
$846.78
base $93.83 · payer covered $696.78
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1993-01-20
- Stop
- 1993-01-20
The parties
- Patient
- patient Larraine Zita Robel
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
2df46b25-4cd4-6fa2-d820-04cf4aaf131a