Claim total
$1,278.56
base $93.83 · payer covered $1,128.56
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1981-11-20
- Stop
- 1981-11-20
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
05c57aa9-c3e8-2f04-7072-c5f5aaed71ef