Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-09-14
- Stop
- 1983-09-14
The parties
- Patient
- patient Wilda Salley Aufderhar
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
132074e8-9d74-8f18-3a1c-b0492a51a71e