Claim total
$282.22
base $155.66 · payer covered $42.50
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2015-07-30
- Stop
- 2015-07-30
The parties
- Provider
- provider Odis Ortiz
- Payer
- payer Medicare
Record id
0366d403-b006-0b76-0064-d2711880373a