Claim total
$1,246.97
base $155.66 · payer covered $0.00
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2002-08-26
- Stop
- 2002-08-26
The parties
- Patient
- patient Ty Cameron Koelpin
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer No insurance
Record id
23667586-d67c-33d2-cd3d-fb3b005c4772