Claim total
$3,935.75
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2018-06-29
- Stop
- 2018-06-29
The parties
- Patient
- patient Marshall Rochel Jacobi
- Provider
- provider Britt Borer
- Care site
- care site OUR LADY OF PEACE HOSPICE
- Payer
- payer No insurance
Record id
38cca9f9-b0e8-26ef-7a8e-5c51406caf52