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
- 2024-12-05
- Stop
- 2024-12-05
The parties
- Patient
- patient Garry Kenton Vandervort
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Cigna Health
Record id
105a5425-4355-e889-4d86-f4e532cf2617