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
- 2025-05-09
- Stop
- 2025-05-09
The parties
- Patient
- patient Theresia Kylie Ferry
- Provider
- provider Elisabeth Smith
- Payer
- payer Aetna
Record id
20b286d8-4a17-89cc-f51e-6ca65fb209d1