Claim total
$1,422.49
base $127.17 · payer covered $1,387.49
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2026-01-16
- Stop
- 2026-01-16
The parties
- Patient
- patient Efren Wilderman
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Dual Eligible
Record id
0400ef40-232f-be7a-706b-450bf8e640cb