Claim total
$13,901.89
base $155.66 · payer covered $13,751.89
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2005-07-05
- Stop
- 2005-07-05
The parties
- Patient
- patient Cecil Smith
- Provider
- provider Clarita Johnston
- Care site
- care site GARGAR URGENT CARE AND CLINIC
- Payer
- payer Medicaid
Record id
29d86494-f39d-b250-7213-b212bc96a5a6