Claim total
$5,623.43
base $155.66 · payer covered $5,588.43
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1981-02-21
- Stop
- 1981-02-21
The parties
- Patient
- patient Arnold O'Keefe
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Dual Eligible
Record id
265323f0-0943-a199-3989-07c6676eedeb