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
- 2020-10-05
- Stop
- 2020-10-05
The parties
- Patient
- patient Gregory Phil Corkery
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0dcdba08-cdbe-f021-c56a-62bfd8c49923