Claim total
$767.69
base $93.83 · payer covered $767.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2017-04-21
- Stop
- 2017-04-21
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-c3e8-2f04-705f-c083c9639d04