Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-07-29
- Stop
- 2021-07-29
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-6a76-7c3d86891174