Claim total
$1,177.77
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1993-11-03
- Stop
- 1993-11-03
The parties
- Patient
- patient Fermina Schneider
- Provider
- provider Jose Pollich
- Care site
- care site ALLIANCE WELLNESS CENTER LLC
- Payer
- payer No insurance
Record id
0fcda0af-82f8-ca7a-430c-68e1423cf156