Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2023-07-28
- Stop
- 2023-07-28
The parties
- Patient
- patient Corliss Stormy Shanahan
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Dual Eligible
Record id
13199f1b-9a57-6e58-97df-23ad87321f1e