Claim total
$155.66
base $155.66 · payer covered $120.66
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2023-04-18
- Stop
- 2023-04-18
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Dual Eligible
Record id
019cda32-2557-7f65-f65d-8ea42436f02e