Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2010-07-31
- Stop
- 2010-07-31
The parties
- Patient
- patient Bambi Adah Koss
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Medicaid
Record id
2d0c65c4-941d-c58c-d39e-08c584471fad