Claim total
$908.61
base $155.66 · payer covered $858.61
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2014-08-07
- Stop
- 2014-08-07
The parties
- Patient
- patient Ezekiel Demarcus Roob
- Provider
- provider Rigoberto Dibbert
- Payer
- payer Medicaid
Record id
2e1a22fb-46ba-3fcc-989c-86c4c15025f1