Claim total
$15,361.54
base $127.17 · payer covered $15,259.14
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-10-31
- Stop
- 2021-10-31
The parties
- Patient
- patient Ja Lori Gottlieb
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
39a9f648-9e90-e24a-540a-2ffab1951c62