Claim total
$75.00
base $75.00 · payer covered $25.00
The visit
- Class
- Virtual
- Code
- 185349003
- Reason
- diagnosis concept Concussion with loss of consciousness62564004
- Start
- 2022-01-10
- Stop
- 2022-01-10
The parties
- Patient
- patient Peg Tresa Cummerata
- Provider
- provider Lady Frami
- Care site
- care site FAIRVIEW RIDGES HOSPITAL
- Payer
- payer Medicaid
Record id
04fb4e35-41c7-7592-6e16-466c9f153296