Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2023-11-08
- Stop
- 2023-11-08
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-bc03-265c1b3b9b3d