Claim total
$1,073.10
base $93.83 · payer covered $973.10
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2021-09-30
- Stop
- 2021-09-30
The parties
- Patient
- patient Florencio Jimmy DuBuque
- Provider
- provider Len Gottlieb
- Care site
- care site CEDAR RIVERSIDE PEOPLES CENTER
- Payer
- payer Medicaid
Record id
350f34bd-fb57-b511-4079-3d28b901e14b