Claim total
$1,104.94
base $155.66 · payer covered $1,054.94
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1972-11-05
- Stop
- 1972-11-05
The parties
- Patient
- patient Lesia Catalina Ledner
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
058279b6-7701-4823-068f-7f80b220ef85