Claim total
$630.24
base $155.66 · payer covered $441.17
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2013-11-07
- Stop
- 2013-11-07
The parties
- Patient
- patient Tamica Sarita Robel
- Provider
- provider Odis Ortiz
Record id
03563bad-3832-f030-8ada-c11b06e57201