Claim total
$1,174.51
base $93.83 · payer covered $1,024.51
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1997-09-10
- Stop
- 1997-09-10
The parties
- Patient
- patient Laverne Stanley Osinski
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
1b725f0a-4f9d-132d-ece3-6c18fed0f476