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
- 2020-01-03
- Stop
- 2020-01-04
The parties
- Patient
- patient Chang Larry Hermiston
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Humana
Record id
3a43a35d-fb85-2922-ca49-915d291d2a89