Claim total
$1,361.07
base $127.17 · payer covered $1,326.07
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of mandible263172003
- Start
- 2015-07-02
- Stop
- 2015-07-02
The parties
- Patient
- patient Delbert Steuber
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Dual Eligible
Record id
23b57b91-5135-9e20-e0e6-19d7d7db72af