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
- 2024-12-22
- Stop
- 2024-12-22
The parties
- Provider
- provider Ricardo Bartoletti
- Care site
- care site MARTIN LUTHER CARE CENTER
- Payer
- payer Medicaid
Record id
04424811-b26b-3a54-0a9c-e00496575f77