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
- 2017-06-08
- Stop
- 2017-06-08
The parties
- Patient
- patient Xuan Clyde Glover
- Provider
- provider Reginald Bruen
- Payer
- payer Medicaid
Record id
126205ae-f6d6-030f-c59d-d0ba6e386f2c