Claim total
$1,321.36
base $93.83 · payer covered $1,286.36
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-09-02
- Stop
- 1971-09-02
The parties
- Patient
- patient Heike Nelida Olson
- Provider
- provider Abram Ullrich
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Dual Eligible
Record id
195810b4-1136-614f-ef1d-00bd66b00037