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
- 1995-08-26
- Stop
- 1995-08-26
The parties
- Patient
- patient Jacqulyn Lavonna Legros
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Humana
Record id
28e07049-ca1f-fcfe-769d-fc5b04f8d29a