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
- 2025-12-28
- Stop
- 2025-12-28
The parties
- Patient
- patient Roger Brain Homenick
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
289be5b0-48cc-7d34-2847-c7fb3cd36684