Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2026-06-26
- Stop
- 2026-06-26
The parties
- Patient
- patient Richie Michael Mante
- Provider
- provider Bennie O'Keefe
- Payer
- payer Medicaid
Record id
12bd5fca-647b-3667-a4b4-c2567e888a1c