Claim total
$979.20
base $155.66 · payer covered $929.20
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2023-11-06
- Stop
- 2023-11-06
The parties
- Patient
- patient Brendon Marcos Sanford
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
032ec4eb-84a5-3e3f-fd1f-865025dfdc9c