Claim total
$841.98
base $155.66 · payer covered $791.98
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1981-05-24
- Stop
- 1981-05-24
The parties
- Patient
- patient Dante Frances Kilback
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Medicaid
Record id
1300e620-3b80-81ae-88e3-83aa2828448d