Claim total
$11,001.31
base $127.17 · payer covered $4,094.87
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 2011-01-05
- Stop
- 2011-01-05
The parties
- Patient
- patient Errol Delmar Lockman
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Aetna
Record id
09a2ab02-bbcf-9b47-52c1-891e1307a5cd