Claim total
$1,575.28
base $155.66 · payer covered $1,540.28
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-06-03
- Stop
- 2020-06-04
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-5716-3cc431f40593