Claim total
$780.15
base $93.83 · payer covered $680.15
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-05-11
- Stop
- 2008-05-11
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-c72f-c470f493a064