Claim total
$772.84
base $93.83 · payer covered $722.84
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1983-07-10
- Stop
- 1983-07-10
The parties
- Patient
- patient Joetta Antonette Bednar
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
2cb8de01-f198-8fe9-6974-21a3aaed3e17