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
- 2021-08-12
- Stop
- 2021-08-12
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-2c8b-673158c0d7ae