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
- 2017-08-31
- Stop
- 2017-08-31
The parties
- Provider
- provider Marquerite Swaniawski
- Payer
- payer Medicaid
Record id
010d736c-d81f-3cd7-ce45-a17503b20da3