Claim total
$843.43
base $93.83 · payer covered $843.43
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2024-06-13
- Stop
- 2024-06-13
The parties
- Patient
- patient Travis Reichert
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
0c81d398-2cb2-843e-f739-43001acb447f