Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2026-06-22
- Stop
- 2026-06-22
The parties
- Patient
- patient Javier Gregorio Mares
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
2d487497-28fb-9da5-dc98-75250d9ee87b