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
- 2017-04-05
- Stop
- 2017-04-05
The parties
- Patient
- patient Lindsay Luigi Moen
- Provider
- provider Elisabeth Smith
Record id
098c4038-017d-a828-aa39-de804d273bce