Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2017-01-08
- Stop
- 2017-01-08
The parties
- Patient
- patient Leta Larisa Anderson
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Medicaid
Record id
1bc8e578-1607-f4cd-ab9d-3ec288cf00ba