Claim total
$15,361.54
base $127.17 · payer covered $15,311.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-06-06
- Stop
- 2025-06-06
The parties
- Patient
- patient Annis Gracie Mills
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Medicaid
Record id
2cb554f7-a08c-3e20-9fbe-47168ffb3558