Claim total
$780.15
base $93.83 · payer covered $546.11
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2016-12-24
- Stop
- 2016-12-24
The parties
- Patient
- patient Berta Cruz
- Provider
- provider Wilfred Dibbert
- Care site
- care site SOUTHDALE INTERNAL MEDICINE PA
- Payer
- payer Cigna Health
Record id
113b9e50-1286-0e01-4244-c0fabfc31b66