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
- 2021-04-06
- Stop
- 2021-04-07
The parties
- Patient
- patient Evan Mario Spinka
- Provider
- provider Allan Rowe
- Payer
- payer Medicaid
Record id
22ab5e98-47e0-5217-b251-bb9268f0da25