Claim total
$3,668.70
base $127.17 · payer covered $3,633.70
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2026-01-21
- Stop
- 2026-01-21
The parties
- Patient
- patient Kallie Roxane Rodriguez
- Provider
- provider Bennie O'Keefe
- Payer
- payer Dual Eligible
Record id
294b84dd-0309-41d1-0ac8-91ed40af5b2d