Claim total
$5,595.82
base $127.17 · payer covered $5,545.82
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2018-05-30
- Stop
- 2018-05-30
The parties
- Patient
- patient Tisa Joya Stoltenberg
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
2debd169-2d62-f488-3263-a992d6c7c2c5