Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 1999-06-29
- Stop
- 1999-06-29
The parties
- Patient
- patient Sherryl Dion Collier
- Provider
- provider Bryce Prohaska
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
2ff124fd-32f0-2d7e-b613-5a2f6e1bfd97