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
- 2025-01-03
- Stop
- 2025-01-04
The parties
- Patient
- patient Esteban Sancho Ornelas
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Cigna Health
Record id
2deabe4d-2e42-b012-af70-0e364b198ab4