Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2014-07-02
- Stop
- 2014-07-02
The parties
- Provider
- provider Abram Ullrich
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
00efc86d-40fa-9fdc-35e2-c3bd9d5c451e