Claim total
$838.96
base $155.66 · payer covered $803.96
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2021-06-17
- Stop
- 2021-06-17
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-b5d0-c46adf350b20