Claim total
$897.95
base $155.66 · payer covered $747.95
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1977-07-15
- Stop
- 1977-07-15
The parties
- Patient
- patient Gabrielle Nidia Heller
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
12861e53-c53d-3b3d-4da2-8ac730c0ff04