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
- 2017-04-12
- Stop
- 2017-04-12
The parties
- Patient
- patient Dione Anissa Jaskolski
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer Dual Eligible
Record id
24b7c6b0-4eef-ea68-6fbe-516971a08236