Claim total
$1,183.80
base $127.17 · payer covered $1,133.80
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Acute allergic reaction241929008
- Start
- 2026-03-31
- Stop
- 2026-03-31
The parties
- Patient
- patient Kendrick Jewell Jerde
- Provider
- provider Ricardo Bartoletti
- Care site
- care site MARTIN LUTHER CARE CENTER
- Payer
- payer Medicaid
Record id
020a56e3-5d79-5c72-6e68-f19a7c91e1a3