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
- 2023-01-23
- Stop
- 2023-01-23
The parties
- Patient
- patient Stefan Romeo Shields
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
310d8e56-3927-7278-b146-cc0ec74ebe0d