Claim total
$1,525.56
base $155.66 · payer covered $1,375.56
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2004-05-14
- Stop
- 2004-05-14
The parties
- Patient
- patient Lee Scot Rosenbaum
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
027e2621-860b-6019-ffbc-faf455951132