Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2022-04-22
- Stop
- 2022-04-22
The parties
- Patient
- patient Coleen Hester Boyle
- Provider
- provider Concepción Baeza
- Care site
- care site GOOD SAMARITAN AMBASSADOR
- Payer
- payer Medicaid
Record id
1fee85c9-7061-f223-04db-74828aa67fd4