Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2014-09-16
- Stop
- 2014-09-18
The parties
- Patient
- patient Maximo Keenan Hane
- Provider
- provider Davida Wolff
- Payer
- payer Medicaid
Record id
1cfe24fb-8d11-3471-971f-9a17ebfece79