Claim total
$630.24
base $155.66 · payer covered $630.24
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2015-10-04
- Stop
- 2015-10-04
The parties
- Patient
- patient Amelia Danyel Hintz
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Humana
Record id
007ab53b-1293-c7a9-3026-28acd02a09a2