Claim total
$1,154.28
base $93.83 · payer covered $1,004.28
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-12-11
- Stop
- 2002-12-11
The parties
- Patient
- patient Soledad Rocio Aguirre
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
060aa7a8-9653-5ae4-8c09-97bdd656ee23