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
- 2022-05-31
- Stop
- 2022-05-31
The parties
- Patient
- patient Nestor Dannie Lockman
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer Medicaid
Record id
1320f2b9-2201-d6ed-dad7-82835c4d6688