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
- 2021-07-22
- Stop
- 2021-07-23
The parties
- Patient
- patient Opal Bethel Mills
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
39143edf-d918-3bcf-5204-922dcb4fb5c0