Claim total
$835.89
base $155.66 · payer covered $0.00
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2019-01-24
- Stop
- 2019-01-24
The parties
- Patient
- patient Tamica Sarita Robel
- Provider
- provider Odis Ortiz
Record id
03563bad-3832-f030-168a-2e6609733e00