Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2026-05-04
- Stop
- 2026-05-04
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
00decd7e-554a-447f-2c15-12a4012d01ad