Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2008-10-23
- Stop
- 2008-10-23
The parties
- Patient
- patient Maria Jerrell Bechtelar
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
0fb9a374-3017-65cf-5d45-c0e278ba5a9d