Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2017-09-30
- Stop
- 2017-09-30
The parties
- Patient
- patient Leigh Julie Koepp
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicare
Record id
06508914-eda7-9758-7b5b-8954b95bf1b5