Claim total
$702.96
base $155.66 · payer covered $652.96
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-11-28
- Stop
- 2020-11-28
The parties
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-f9dd-6911f2175123