Claim total
$1,172.41
base $155.66 · payer covered $1,122.41
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2016-01-17
- Stop
- 2016-01-17
The parties
- Patient
- patient Cecil Norberto Franecki
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
05e47734-a2d3-8a46-a856-eba65e6502cc