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
- 2021-04-16
- Stop
- 2021-04-16
The parties
- Patient
- patient Bennie Breitenberg
- Provider
- provider Evalyn Torphy
- Care site
- care site ALLIANCE HHC & NURSING SERVICE
- Payer
- payer Medicaid
Record id
387f90ae-8393-d71f-ccf1-7d382ef205ee