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
- 1989-06-17
- Stop
- 1989-06-17
The parties
- Patient
- patient Buddy Bradly Bradtke
- Provider
- provider Camelia Hodkiewicz
- Care site
- care site CHI HEALTH AT HOME
- Payer
- payer Medicaid
Record id
207161b0-f503-ec70-2a81-edb2d372e385