Claim total
$15,191.96
base $93.83 · payer covered $15,191.96
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-12-23
- Stop
- 2021-12-23
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-486c-e2e083306d40