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
- 2005-04-24
- Stop
- 2005-04-24
The parties
- Patient
- patient Rick Miles Lockman
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicare
Record id
2f111109-230b-28cb-1e5d-aee9b9c28afa