Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2023-04-27
- Stop
- 2023-04-28
The parties
- Patient
- patient Tia Ellan Hickle
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
2e005e83-bf8f-1b2f-ba0a-011d4da52f74