Claim total
$979.20
base $155.66 · payer covered $692.12
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2015-12-27
- Stop
- 2015-12-27
The parties
- Patient
- patient Denyse Fadel
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Anthem
Record id
048ae427-86b6-6ce9-f2ec-3b5403d49a54