Claim total
$16,569.23
base $127.17 · payer covered $16,534.23
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2024-04-28
- Stop
- 2024-04-28
The parties
- Patient
- patient Ted Claude O'Conner
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Dual Eligible
Record id
2ef29fe0-cf19-e6ae-86a8-d9ca16cb15ad