Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-02-02
- Stop
- 2021-02-02
The parties
- Patient
- patient Deirdre Shannon Hayes
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
0194ec83-bb8c-3a71-ae56-3508f3f877af