Claim total
$897.95
base $155.66 · payer covered $747.95
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2016-08-13
- Stop
- 2016-08-13
The parties
- Patient
- patient America Bernita Cronin
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
0d047f1f-2497-6e70-7281-dafe2c6b5b8b