Claim total
$1,138.24
base $93.83 · payer covered $1,138.24
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2019-07-06
- Stop
- 2019-07-06
The parties
- Patient
- patient Isaac Roberto Goyette
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Dual Eligible
Record id
29b08593-21af-d81d-a3f1-273628be55bd