Claim total
$127.17
base $127.17 · payer covered $127.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2024-05-26
- Stop
- 2024-05-26
The parties
- Patient
- patient Crista Karina Nienow
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
0266f4cc-2c2d-37bb-efe0-d7a9511db97a