Claim total
$3,870.80
base $127.17 · payer covered $3,835.80
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 1968-08-19
- Stop
- 1968-08-19
The parties
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Dual Eligible
Record id
17c007ab-2a20-dadb-dfd0-ce7551b49dfc