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
- 2026-09-03
- Stop
- 2026-09-03
The parties
- Patient
- patient Tomas Josh Larson
- Provider
- provider Grant Miller
- Care site
- care site OUR LADY OF PEACE HOME CARE
- Payer
- payer No insurance
Record id
2f6a8fd0-a41d-4cac-bad0-56643228a3ab