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
- 2024-08-25
- Stop
- 2024-08-25
The parties
- Patient
- patient Shea Sudie Konopelski
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
3566c91d-8b1c-413e-01ca-5ed351c2b4ef