Claim total
$14,609.64
base $93.83 · payer covered $11,687.71
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2020-12-14
- Stop
- 2020-12-14
The parties
- Patient
- patient Maria Dibbert
- Provider
- provider Dominick West
- Payer
- payer Medicare
Record id
000287f5-a0d8-f77b-dd1a-d6c4be660dbe