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
- 2024-10-19
- Stop
- 2024-10-19
The parties
- Patient
- patient Virgil Nona Cartwright
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2e2c7652-cf1c-40f1-f5c7-efa899ce68f7