Claim total
$1,361.07
base $127.17 · payer covered $1,311.07
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 2026-04-25
- Stop
- 2026-04-25
The parties
- Patient
- patient Casey Lino Russel
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
30523c73-61ea-cd3b-92d6-15dde0eb1186