Claim total
$1,104.82
base $155.66 · payer covered $1,069.82
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-07-15
- Stop
- 2020-07-16
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-ea0c-9b3602210698