Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2017-12-22
- Stop
- 2017-12-22
The parties
- Patient
- patient Angila Delfina Friesen
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Medicaid
Record id
2fb62ca5-b037-fe29-0ed3-53116d9b19c2