Claim total
$949.77
base $127.17 · payer covered $759.82
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2026-04-15
- Stop
- 2026-04-15
The parties
- Patient
- patient Matthew Otis Herman
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Anthem
Record id
3501ea6b-13e3-1b87-0e3e-bbc5e4747f13