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
- 2016-12-03
- Stop
- 2016-12-03
The parties
- Patient
- patient Lorenzo Alberto Upton
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicare
Record id
0c0591a9-0f49-c13a-676a-8bfd4c46e7bf