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
- 2018-04-18
- Stop
- 2018-04-18
The parties
- Patient
- patient Arnulfo Garland Bins
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
1ba5d21e-35d3-3dde-894e-27a7dd4c902c