Claim total
$4,854.63
base $127.17 · payer covered $3,883.71
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2015-12-27
- Stop
- 2015-12-28
The parties
- Patient
- patient Domenic Brock Dach
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Medicare
Record id
19137cbd-9649-bf65-c64b-28d953f3e549