Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2016-11-04
- Stop
- 2016-11-04
The parties
- Patient
- patient Ricky Cary Rodriguez
- Provider
- provider Elisabeth Smith
- Payer
- payer Medicaid
Record id
202fa83b-fd21-ac90-2408-cf905b66b89b