Claim total
$1,247.61
base $155.66 · payer covered $1,247.61
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2015-08-02
- Stop
- 2015-08-02
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-ff8c-48a4d3fc4dc1