Claim total
$5,112.47
base $127.17 · payer covered $4,089.98
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2021-07-03
- Stop
- 2021-07-03
The parties
- Patient
- patient Cleopatra Bechtelar
- Provider
- provider Ismael Botsford
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Medicare
Record id
2ac52291-c2c9-0ab9-2c8c-3ce2b796e4c6