Claim total
$900.11
base $155.66 · payer covered $850.11
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2012-08-22
- Stop
- 2012-08-23
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
03ef4f74-940b-d219-290a-f679cbbc2b0d