Claim total
$127.17
base $127.17 · payer covered $127.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Concussion injury of brain110030002
- Start
- 2024-01-02
- Stop
- 2024-01-02
The parties
- Patient
- patient Jared Lenard Hansen
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Aetna
Record id
047ee4ec-c50b-b504-aabe-89ed3af3ab59