Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2008-01-16
- Stop
- 2008-01-16
The parties
- Patient
- patient Chi Yesenia Sanford
- Provider
- provider Sheree Kreiger
- Care site
- care site MARANATHA CARE CENTER
- Payer
- payer Dual Eligible
Record id
33c6a998-1b9c-bb04-ee6e-d4486b44df6e