Claim total
$1,390.50
base $155.66 · payer covered $1,112.40
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2013-05-14
- Stop
- 2013-05-14
The parties
- Patient
- patient Jacqui Bess Baumbach
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicare
Record id
019cda32-2557-7f65-d405-ae912de13df1