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
- 2021-04-30
- Stop
- 2021-04-30
The parties
- Patient
- patient Ayako Tynisha Konopelski
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2d5fef92-5b93-765b-97d1-f9c66ec54c81