Claim total
$4,580.00
base $93.83 · payer covered $4,580.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-11-13
- Stop
- 2014-11-13
The parties
- Patient
- patient Augustus Lyman Schmitt
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Dual Eligible
Record id
11e13b06-cce6-c88c-b048-28cb88a556f7