Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2026-09-10
- Stop
- 2026-09-10
The parties
- Patient
- patient Alva Randy Gislason
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
06b076c2-4241-661b-fc9d-85786515a686