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
- 2015-05-21
- Stop
- 2015-05-21
The parties
- Patient
- patient Akilah Ebert
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Dual Eligible
Record id
1ef9913f-d7aa-d611-698a-47a70228e6ec