Claim total
$1,442.56
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2025-02-26
- Stop
- 2025-02-26
The parties
- Patient
- patient Laurence Erik Fadel
- Provider
- provider Wilfred Dibbert
- Care site
- care site SOUTHDALE INTERNAL MEDICINE PA
- Payer
- payer Humana
Record id
39bc3cd4-7de3-c106-8e38-dbc888c0b614