Claim total
$702.96
base $155.66 · payer covered $652.96
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 1995-04-02
- Stop
- 1995-04-02
The parties
- Patient
- patient Quintin Loyd Ullrich
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicaid
Record id
33a68753-f79f-bb9d-5ae7-3567efb1775e