Claim total
$5,582.64
base $155.66 · payer covered $4,466.09
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1987-11-12
- Stop
- 1987-11-12
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Odis Ortiz
- Payer
- payer Medicare
Record id
04371635-b149-02a5-f62e-c3977c099fbe