Claim total
$962.45
base $155.66 · payer covered $912.45
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2020-10-11
- Stop
- 2020-10-11
The parties
- Patient
- patient Jesse Roosevelt Wolf
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
26aa011e-0d75-d1a3-f7fc-b5f7a0f6ff86