Claim total
$773.55
base $155.66 · payer covered $723.55
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1988-04-26
- Stop
- 1988-04-26
The parties
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
0126321a-a5af-784d-d65b-c9138a001d23