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
- 2024-08-07
- Stop
- 2024-08-07
The parties
- Patient
- patient Evelyne Minda Denesik
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
0d9d9f81-b2ab-7b08-b14a-2070a3fff44b