Claim total
$949.77
base $127.17 · payer covered $914.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-02-05
- Stop
- 2025-02-05
The parties
- Patient
- patient Erika Predovic
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Dual Eligible
Record id
1a9016a2-45a9-4f54-7f4c-558cd84d52a9