Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2024-04-23
- Stop
- 2024-04-23
The parties
- Patient
- patient Cleopatra Bechtelar
- Provider
- provider Ismael Botsford
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Medicare
Record id
2ac52291-c2c9-0ab9-53d4-d3d573dbca45