Claim total
$127.17
base $127.17 · payer covered $24.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2019-03-05
- Stop
- 2019-03-06
The parties
- Patient
- patient Jacobo Homero Zaragoza
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
3801a1fa-983c-995f-c785-db249b0ae8c0