Claim total
$5,290.18
base $127.17 · payer covered $5,240.18
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-12-06
- Stop
- 2025-12-06
The parties
- Patient
- patient Rosalina Logan Moen
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
1c09be84-1451-6ed1-c4fd-e8d90fec6e43