Claim total
$1,127.11
base $93.83 · payer covered $1,027.11
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-12-29
- Stop
- 2019-12-29
The parties
- Patient
- patient Chelsea Lillie Connelly
- Provider
- provider Billie Abbott
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
15e4e886-ae0d-3af0-5696-a5b321ca9c2d