General examination of patient

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patient Delilah Cleotilde Goldner
General examination of patient

Claim total

$704.41

base $93.83 · payer covered $0.00

The visit

Class: Wellness
Code: 162673000
Reason: —
Start: 2020-03-22
Stop: 2020-03-22

The parties

Patient: patient Delilah Cleotilde Goldner
Provider: provider Abram Ullrich
Care site: care site CEDAR RIVERSIDE PEOPLES CENTER
Payer: payer Blue Cross Blue Shield

Record id 05f1dbc7-3ebc-37ee-f583-12aaba7a31b1