Claim total
$699.66
base $155.66 · payer covered $649.66
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2022-03-13
- Stop
- 2022-03-13
The parties
- Patient
- patient Danyell Anya Gislason
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
00b8faa9-dae2-fa2d-7b8d-a00a062eed3a