Claim total
$908.61
base $155.66 · payer covered $858.61
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2019-10-16
- Stop
- 2019-10-16
The parties
- Patient
- patient Amanda Rheba Mitchell
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
0363ed75-83f4-7675-2026-af25ce756250