Claim total
$4,854.63
base $127.17 · payer covered $4,819.63
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2014-07-27
- Stop
- 2014-07-27
The parties
- Patient
- patient Solomon Amado Purdy
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Dual Eligible
Record id
1e6fa6a9-1f41-5355-6c30-602412185db7