Claim total
$1,180.97
base $93.83 · payer covered $1,030.97
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1954-06-22
- Stop
- 1954-06-22
The parties
- Patient
- patient Toshiko Sybil King
- Provider
- provider Abram Ullrich
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
106257f3-21d9-7a09-60b2-f6354ef70e8c