Claim total
$1,047.00
base $93.83 · payer covered $661.51
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-09-03
- Stop
- 2011-09-03
The parties
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicare
Record id
018a1080-c6e3-9b93-52b5-70b67b8f095b