Claim total
$1,047.63
base $155.66 · payer covered $997.63
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1965-07-05
- Stop
- 1965-07-05
The parties
- Patient
- patient Andree Agatha Krajcik
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Medicaid
Record id
115c2159-d4c7-04f2-5a15-6d0a95be22bb