Claim total
$906.71
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-01-31
- Stop
- 2024-01-31
The parties
- Patient
- patient Gerda Leslie Hagenes
- Provider
- provider Roxana Schuppe
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer UnitedHealthcare
Record id
21879068-ff65-6943-b5cf-70481e600ea8