Claim total
$155.66
base $155.66 · payer covered $120.66
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2025-01-05
- Stop
- 2025-01-05
The parties
- Patient
- patient Stacy Herzog
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
070c7867-fbf2-7941-ef87-7c1531c17657