Claim total
$1,523.14
base $93.83 · payer covered $1,373.14
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-01-18
- Stop
- 2002-01-19
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
05c57aa9-c3e8-2f04-b1f4-120525b14722