Claim total
$3,935.75
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-12-01
- Stop
- 2017-12-01
The parties
- Patient
- patient Dacia Emilie Beahan
- Provider
- provider Elisabeth Smith
- Payer
- payer Humana
Record id
20ef5063-3118-2154-f864-3b685ebe0ce0