Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2018-08-31
- Stop
- 2018-08-31
The parties
- Patient
- patient Donita Kasandra Crooks
- Provider
- provider Britt Borer
- Care site
- care site OUR LADY OF PEACE HOSPICE
- Payer
- payer Medicare
Record id
277f7208-da9a-7c08-3677-03b2d446a2ae