Claim total
$4,854.63
base $127.17 · payer covered $3,871.28
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2024-09-26
- Stop
- 2024-09-27
The parties
- Patient
- patient Sarah Grace Rodriguez
- Provider
- provider Ismael Botsford
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Medicare
Record id
0b148eae-85bf-c41d-3fab-f20fc453018e