Claim total
$756.80
base $155.66 · payer covered $721.80
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2023-08-23
- Stop
- 2023-08-24
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-a031-a67c34a74c2f