Claim total
$155.66
base $155.66 · payer covered $105.66
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2024-04-02
- Stop
- 2024-04-02
The parties
- Patient
- patient Cristobal Dana Wolf
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
016cc0d6-9a88-e8dc-892b-59109ebed4df