Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2026-01-14
- Stop
- 2026-01-14
The parties
- Provider
- provider Alia Gaylord
- Care site
- care site MIDWEST HOME HEALTHCARE LLC
- Payer
- payer Dual Eligible
Record id
014b9cfb-a71a-d032-b7f6-6c31114db80a