Claim total
$13,551.56
base $155.66 · payer covered $13,401.56
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1981-10-13
- Stop
- 1981-10-14
The parties
- Patient
- patient Benito Beau Keebler
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Medicaid
Record id
21f14afd-a65c-85c6-d325-46d5723e35d3