Claim total
$949.77
base $127.17 · payer covered $899.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2019-05-24
- Stop
- 2019-05-24
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-d964-617063c65fbb