Claim total
$1,049.08
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1971-10-30
- Stop
- 1971-10-30
The parties
- Patient
- patient Allan Ivan Kuphal
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer No insurance
Record id
2cc14d47-c00d-f33b-6eb0-cab27efc4c1e