Claim total
$1,161.73
base $155.66 · payer covered $1,126.73
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2011-04-29
- Stop
- 2011-04-29
The parties
- Patient
- patient Nena Josephine Stehr
- Provider
- provider Clarita Johnston
- Care site
- care site GARGAR URGENT CARE AND CLINIC
- Payer
- payer Dual Eligible
Record id
00eec58c-8547-4a29-bf8c-093ee1626f59