Claim total
$127.17
base $127.17 · payer covered $54.34
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 1992-07-12
- Stop
- 1992-07-12
The parties
- Patient
- patient Shaina Wolff
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
131b868f-c77f-95c7-9dd4-8c06e11c0fbd