Claim total
$127.17
base $127.17 · payer covered $89.02
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2021-06-12
- Stop
- 2021-06-12
The parties
- Patient
- patient Nelda Ebony Jerde
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
Record id
1746240e-c6cd-a5fb-3ac6-aa3e8fc9a027