Claim total
$12,361.10
base $155.66 · payer covered $12,211.10
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1968-07-25
- Stop
- 1968-07-25
The parties
- Patient
- patient Leroy Jimmy Wintheiser
- Provider
- provider Odis Ortiz
- Payer
- payer Medicaid
Record id
04371635-b149-02a5-98cb-98117371af42