Claim total
$704.41
base $93.83 · payer covered $704.41
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2022-05-20
- Stop
- 2022-05-20
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-e2fc-7e4ff7418d53