Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2015-09-28
- Stop
- 2015-09-28
The parties
- Patient
- patient Sommer Lila Goodwin
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
24d76e87-c27b-19c2-8fa7-13297be7cd2f