Claim total
$505.13
base $93.83 · payer covered $455.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 1932-11-24
- Stop
- 1932-11-24
The parties
- Patient
- patient Luis Block
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
081ceedd-df07-7c20-b39d-991da052773f