Claim total
$1,495.23
base $155.66 · payer covered $1,445.23
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1981-10-19
- Stop
- 1981-10-19
The parties
- Patient
- patient Simona Abbey Hodkiewicz
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
28cc646f-6044-8ac8-1990-d551e1988edc