Claim total
$1,142.19
base $155.66 · payer covered $1,107.19
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-08-12
- Stop
- 2020-08-13
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
03ef4f74-940b-d219-fa72-a790b32eb451