Claim total
$1,560.35
base $127.17 · payer covered $1,410.35
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2015-06-05
- Stop
- 2015-06-05
The parties
- Patient
- patient Fay Danyell Wilderman
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
310f7b88-3df4-237f-7320-29ce603ba3ea