Claim total
$911.00
base $93.83 · payer covered $861.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1994-02-16
- Stop
- 1994-02-16
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-bf1b-5c76f291e584