Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2018-10-20
- Stop
- 2018-10-20
The parties
- Patient
- patient Hien Shasta Nikolaus
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
1feed5c5-ef44-d1c7-22ae-eb3bb1402ce6