Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2021-03-08
- Stop
- 2021-03-08
The parties
- Patient
- patient Madalyn Dulcie Toy
- Provider
- provider Britt Borer
- Care site
- care site OUR LADY OF PEACE HOSPICE
- Payer
- payer Medicaid
Record id
1b71b777-175c-1edb-4d88-38bddf351a3b