Claim total
$1,089.15
base $155.66 · payer covered $777.79
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2002-01-05
- Stop
- 2002-01-05
The parties
- Provider
- provider Odis Ortiz
- Payer
- payer Medicare
Record id
14f87ac6-4d7d-9114-b450-9beaca84d658