Claim total
$756.80
base $155.66 · payer covered $721.80
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2021-09-01
- Stop
- 2021-09-02
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-6210-9bae70fc56f2