Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of neck90460009
- Start
- 2018-03-11
- Stop
- 2018-03-11
The parties
- Patient
- patient Jarvis Konopelski
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer Medicaid
Record id
2029313b-bf4f-fef4-a807-f4c792a40cc7