Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 1981-08-11
- Stop
- 1981-08-11
The parties
- Patient
- patient Neta Merlyn Jacobi
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
23e58a81-7a21-4aa2-88db-679b7354b0da