Claim total
$820.08
base $155.66 · payer covered $785.08
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2015-09-23
- Stop
- 2015-09-23
The parties
- Patient
- patient Quinton Lueilwitz
- Provider
- provider Odis Ortiz
- Payer
- payer Dual Eligible
Record id
19beb540-4cdd-68a1-a35a-bb5582454c58