Claim total
$155.66
base $155.66 · payer covered $120.66
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2018-05-31
- Stop
- 2018-05-31
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-a6ae-050fc60a588d