Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2020-10-04
- Stop
- 2020-10-04
The parties
- Patient
- patient Maia Chelsie Runolfsson
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Medicaid
Record id
171169a6-b136-3c65-ac3f-707611804b7c