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
- 2025-10-14
- Stop
- 2025-10-14
The parties
- Patient
- patient Gary Carolynn Bergstrom
- Provider
- provider Ricardo Bartoletti
- Care site
- care site MARTIN LUTHER CARE CENTER
- Payer
- payer Humana
Record id
286699ff-b159-7b1a-4c4b-3bf8a67a4a98