Claim total
$1,112.13
base $155.66 · payer covered $1,077.13
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-09-13
- Stop
- 2020-09-13
The parties
- Patient
- patient Manuel Dusty Mitchell
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
391ddd05-98fd-5656-f1b0-1ac183ea0175