Claim total
$949.77
base $127.17 · payer covered $664.84
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-05-07
- Stop
- 2025-05-07
The parties
- Patient
- patient Toni Jin Smitham
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Cigna Health
Record id
34d094b9-9371-6558-3ec0-a752e8776f52