Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2008-11-13
- Stop
- 2008-11-13
The parties
- Patient
- patient Frederick Wilford Stamm
- Provider
- provider Emmanuel Champlin
- Care site
- care site CREST VIEW HOME HEALTH CARE
- Payer
- payer Medicaid
Record id
359e3dbe-3eb2-f8ad-4db5-47f979a065d0