Claim total
$7,925.16
base $127.17 · payer covered $7,890.16
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 1996-04-06
- Stop
- 1996-04-06
The parties
- Patient
- patient Chantelle Colby Dibbert
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Dual Eligible
Record id
23b0353c-2171-2057-e7b4-de861740ceea