Claim total
$1,061.48
base $155.66 · payer covered $849.18
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2003-06-12
- Stop
- 2003-06-12
The parties
- Patient
- patient Sumiko Bethann Baumbach
- Provider
- provider Odis Ortiz
- Payer
- payer Medicare
Record id
23c570a1-24f2-7527-ff39-bde0532cfabe