Claim total
$18,945.22
base $93.83 · payer covered $18,945.22
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2018-04-27
- Stop
- 2018-04-27
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-d560-d22b3ed3872d