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
- 2018-07-31
- Stop
- 2018-07-31
The parties
- Patient
- patient Etta Daugherty
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Anthem
Record id
1b5eead1-789b-3423-054c-7d570e5f29c5