Claim total
$974.28
base $93.83 · payer covered $874.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-07-25
- Stop
- 2021-07-25
The parties
- Patient
- patient Connie Buck Hane
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
02070c62-d383-1025-c4fd-8f2ebec60281