Claim total
$1,191.80
base $93.83 · payer covered $0.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1987-10-13
- Stop
- 1987-10-13
The parties
- Patient
- patient Carmen Gia Robel
- Provider
- provider Wilfred Dibbert
- Care site
- care site SOUTHDALE INTERNAL MEDICINE PA
- Payer
- payer No insurance
Record id
0b18fec5-d601-b59b-bc1c-65def2e8c562