Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 1994-01-09
- Stop
- 1994-01-09
The parties
- Patient
- patient Domenic Brock Dach
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Humana
Record id
19137cbd-9649-bf65-13c8-466f05311747