Claim total
$12,724.62
base $127.17 · payer covered $10,179.70
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-04-30
- Stop
- 2017-04-30
The parties
- Patient
- patient Carla María Luisa León
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer Anthem
Record id
1d508144-53cb-4866-d52e-2ac2d7814cda