Claim total
$702.96
base $155.66 · payer covered $667.96
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1973-10-14
- Stop
- 1973-10-14
The parties
- Patient
- patient Basil Josef Bosco
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Dual Eligible
Record id
03478e49-59cf-7140-0aaf-90453298454e