Claim total
$1,225.78
base $93.83 · payer covered $1,075.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-04-21
- Stop
- 2002-04-21
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Billie Abbott
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-8de2-f679787bf63f