Claim total
$641.13
base $93.83 · payer covered $491.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1958-01-03
- Stop
- 1958-01-04
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-c3e8-2f04-46da-688d11cabdb4