Claim total
$1,207.56
base $93.83 · payer covered $1,107.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-01-24
- Stop
- 2015-01-24
The parties
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-0ee7-3092b11f56d6