Claim total
$566.96
base $155.66 · payer covered $516.96
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2024-03-26
- Stop
- 2024-03-26
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-ce5c-b9054d58b715