Claim total
$910.06
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-06-01
- Stop
- 2015-06-01
The parties
- Patient
- patient Dara Dicki
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
Record id
3681da1b-d694-6521-e805-32568d6b5ebe