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
- 2019-01-18
- Stop
- 2019-01-18
The parties
- Patient
- patient Hilton Marcelino Friesen
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Cigna Health
Record id
069d1f4a-1b6f-6d04-74cb-da8f9e057fe7