Claim total
$15,361.54
base $127.17 · payer covered $15,311.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-12-22
- Stop
- 2021-12-22
The parties
- Patient
- patient Mathilda Ozella Haag
- Provider
- provider Marquerite Swaniawski
- Payer
- payer Medicaid
Record id
2a63cfc1-6750-4ae6-841d-7a56ffdc46d3