Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2022-01-24
- Stop
- 2022-01-24
The parties
- Patient
- patient Abdul Sammie Spencer
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Medicaid
Record id
009b9fb1-8515-f33d-683c-62941f12de2a