Claim total
$1,779.69
base $93.83 · payer covered $1,679.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-06-22
- Stop
- 2019-06-22
The parties
- Patient
- patient Gerardo Armando Salinas
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicaid
Record id
167ac4fe-9052-35f2-2a72-266d7d7fab08