Claim total
$5,243.33
base $127.17 · payer covered $5,193.33
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2020-07-25
- Stop
- 2020-07-25
The parties
- Patient
- patient Carolina Mayte Rael
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Medicaid
Record id
2abfba6d-130d-6d06-0a5e-15edb023e7b2