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
- 2017-04-20
- Stop
- 2017-04-20
The parties
- Patient
- patient Branden Milford Ullrich
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer Medicaid
Record id
10ef12fb-14dc-88af-df12-ad4eba866d37