Claim total
$767.69
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1968-06-17
- Stop
- 1968-06-17
The parties
- Patient
- patient Denny Rodrigo Cole
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
01d0b380-425a-3ac7-3a3d-f0f8c0da1dea