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
- 2024-06-04
- Stop
- 2024-06-04
The parties
- Patient
- patient Penni Swaniawski
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
34d3fbff-8793-d2f0-0d5b-c875acd478d4