Claim total
$1,323.78
base $155.66 · payer covered $1,273.78
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1996-11-08
- Stop
- 1996-11-08
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Clarita Johnston
- Care site
- care site GARGAR URGENT CARE AND CLINIC
- Payer
- payer Medicaid
Record id
0400ef40-232f-be7a-d47f-d10699e2d822