Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2014-08-03
- Stop
- 2014-08-03
The parties
- Patient
- patient Isela Lisbeth Lang
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
310def7b-a5c6-df96-5daa-4e0abcf13f1b