Claim total
$5,740.82
base $155.66 · payer covered $5,690.82
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2016-06-23
- Stop
- 2016-06-23
The parties
- Patient
- patient Laveta Russel
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
01e64c71-bb1e-2212-fbbb-a9a563123eda