Claim total
$6,248.59
base $155.66 · payer covered $6,198.59
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2016-06-16
- Stop
- 2016-06-16
The parties
- Patient
- patient Laveta Russel
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
01e64c71-bb1e-2212-80b0-a6229eaf67b3