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
- 2023-12-10
- Stop
- 2023-12-10
The parties
- Patient
- patient Marylou Luci Blanda
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer No insurance
Record id
1e1c2fac-caa8-1b64-c863-f71061215f78