Claim total
$1,069.75
base $155.66 · payer covered $1,034.75
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2025-03-19
- Stop
- 2025-03-20
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-d14e-ac0d81bc5c14