Claim total
$913.08
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1938-04-23
- Stop
- 1938-04-23
The parties
- Patient
- patient Elbert Jamar Grant
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
1f492d1b-46b8-92c2-e95f-d82c1c99db92