Claim total
$5,500.29
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-07-15
- Stop
- 2025-07-15
The parties
- Patient
- patient Hong Sung Jacobi
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer No insurance
Record id
1ef14b16-af14-fc23-42a8-be529f060e86