Claim total
$767.69
base $93.83 · payer covered $667.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2015-06-21
- Stop
- 2015-06-21
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-0197-9322715bcaa4