Claim total
$894.25
base $93.83 · payer covered $715.38
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-11-11
- Stop
- 2023-11-11
The parties
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Medicare
Record id
018a1080-c6e3-9b93-7413-8a548517636b