Claim total
$13,059.39
base $127.17 · payer covered $13,009.39
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-01-25
- Stop
- 2025-01-25
The parties
- Patient
- patient Chuck Ignacio Pouros
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Medicaid
Record id
28b39e0c-3fe7-89ce-325c-be5067c17deb