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
- 2014-01-29
- Stop
- 2014-01-29
The parties
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicare
Record id
17bc2196-5977-7a0f-9a31-9d4028b8c556