Claim total
$5,943.68
base $155.66 · payer covered $5,908.68
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1991-07-16
- Stop
- 1991-07-16
The parties
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
0126321a-a5af-784d-fc18-61c4de8b6966