Claim total
$4,096.44
base $155.66 · payer covered $1,867.82
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2007-03-15
- Stop
- 2007-03-15
The parties
- Patient
- patient Carylon Sharlene Reilly
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Humana
Record id
0f07fc79-9416-3271-4674-1208327ee5ff