Claim total
$843.43
base $93.83 · payer covered $770.60
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1992-09-19
- Stop
- 1992-09-19
The parties
- Patient
- patient Maricela Gaye Labadie
- Provider
- provider Dorene Swaniawski
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
204f0e38-5f88-c3c2-011d-ac7c7db7807b