Claim total
$772.61
base $155.66 · payer covered $737.61
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2023-11-05
- Stop
- 2023-11-05
The parties
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-5cc7-46cb4b94dfc2