Claim total
$911.63
base $155.66 · payer covered $861.63
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1954-07-16
- Stop
- 1954-07-16
The parties
- Patient
- patient Akilah Ebert
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
1ef9913f-d7aa-d611-ab8b-f47825262cf8