Claim total
$1,112.41
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2024-08-27
- Stop
- 2024-08-27
The parties
- Patient
- patient Amalia Ana María Soliz
- Provider
- provider Abram Ullrich
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Anthem
Record id
007eb971-e9c1-129f-a03a-97912f45017f