Claim total
$780.15
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1995-12-17
- Stop
- 1995-12-17
The parties
- Patient
- patient Awilda Joana Ebert
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
3424d196-47e2-4a3e-e378-417321068e35