Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-12-28
- Stop
- 2021-12-28
The parties
- Patient
- patient Lonnie Dibbert
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Medicaid
Record id
1a9d77bd-337f-3ffc-1aa3-87827d5d2e6d