Claim total
$4,854.63
base $127.17 · payer covered $498.76
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2018-12-28
- Stop
- 2018-12-28
The parties
- Patient
- patient Milford Alfonso Thiel
- Provider
- provider Elisabeth Smith
- Payer
- payer Cigna Health
Record id
1f816600-b043-d586-d76b-2a1984f76571