Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2005-05-06
- Stop
- 2005-05-06
The parties
- Patient
- patient Olin Stefan Von
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
20a1fdbb-e395-532e-0265-8ad8b42d2995