Claim total
$15,361.54
base $127.17 · payer covered $15,326.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2022-08-11
- Stop
- 2022-08-11
The parties
- Patient
- patient Adrian Arden Haag
- Provider
- provider Elisabeth Smith
- Payer
- payer Dual Eligible
Record id
341d0f9d-7d8e-e18c-11a9-504bbcae539e