Claim total
$949.77
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2016-09-21
- Stop
- 2016-09-21
The parties
- Patient
- patient Gwenn Xochitl Pollich
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Humana
Record id
36bd080b-6e6b-6abc-ecca-2994bd68bed9