Claim total
$393.54
base $155.66 · payer covered $358.54
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2026-01-23
- Stop
- 2026-01-23
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Clarita Johnston
- Care site
- care site GARGAR URGENT CARE AND CLINIC
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-e6bb-5e461722d485