Claim total
$1,043.74
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2013-07-27
- Stop
- 2013-07-27
The parties
- Patient
- patient Lucia Claudia Gonzales
- Provider
- provider Abram Ullrich
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Anthem
Record id
0d82452b-5d70-c48a-b5f0-ead853f022b5