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
- 2017-03-22
- Stop
- 2017-03-22
The parties
- Patient
- patient Cassie Kristina Hoeger
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer UnitedHealthcare
Record id
0071794d-67c4-c06b-8abf-3aa2c867a3c5