Claim total
$16,483.15
base $127.17 · payer covered $16,433.15
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 2025-06-05
- Stop
- 2025-06-05
The parties
- Patient
- patient Kip Denver McKenzie
- Provider
- provider Elisabeth Smith
- Payer
- payer Medicaid
Record id
2503f21b-df26-a5c8-f515-99cef97da57d