Claim total
$5,888.24
base $93.83 · payer covered $4,710.58
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2011-10-17
- Stop
- 2011-10-17
The parties
- Patient
- patient Maria Dibbert
- Provider
- provider Dominick West
- Payer
- payer Medicare
Record id
000287f5-a0d8-f77b-e386-365ebdc396d0