Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2022-05-01
- Stop
- 2022-05-01
The parties
- Patient
- patient Mason Jeffry Vandervort
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
1a73a6e9-3ff1-67cc-55b1-d12539b90157