Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2022-12-04
- Stop
- 2022-12-04
The parties
- Patient
- patient Ja Lori Gottlieb
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
39a9f648-9e90-e24a-7384-3b8436fc0301