Claim total
$756.80
base $155.66 · payer covered $721.80
The visit
- Class
- Urgent care
- Code
- 702927004
- Reason
- —
- Start
- 2004-12-27
- Stop
- 2004-12-27
The parties
- Patient
- patient Elden Cary DuBuque
- Provider
- provider Thao Terry
- Care site
- care site URGENT AMERIKAN CLINIC
- Payer
- payer Dual Eligible
Record id
2f6fe81f-21ca-2f76-bfec-7d5eacc6afd0