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
- 2020-10-20
- Stop
- 2020-10-20
The parties
- Patient
- patient Shavon Mireille Spinka
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
2cb985b7-576b-b3f4-e4d5-abff4535ea62