Claim total
$971.89
base $155.66 · payer covered $777.51
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2004-04-21
- Stop
- 2004-04-21
The parties
- Patient
- patient Donny Wilfred Ruecker
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Medicare
Record id
0054427e-44d7-94b2-ea12-abb6d45b267b