Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 1996-07-27
- Stop
- 1996-07-27
The parties
- Patient
- patient Flor Georgina Pollich
- Provider
- provider Elisabeth Smith
- Payer
- payer Medicaid
Record id
35733c37-83e7-4a67-5ac3-9d45396d4523