Claim total
$846.78
base $93.83 · payer covered $846.78
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-05-03
- Stop
- 2019-05-03
The parties
- Patient
- patient Jewel Chi Harris
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer Dual Eligible
Record id
05c57aa9-c3e8-2f04-0165-53fdcdd48b6c