Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2021-05-10
- Stop
- 2021-05-10
The parties
- Patient
- patient Federico Carroll Grady
- Provider
- provider Britt Borer
- Care site
- care site OUR LADY OF PEACE HOSPICE
- Payer
- payer Medicaid
Record id
0d96c26e-79fa-1a73-6e24-73ce4c81478a