Claim total
$1,590.89
base $155.66 · payer covered $1,540.89
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2017-05-17
- Stop
- 2017-05-18
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
03ef4f74-940b-d219-9141-fd420c96ac72