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
- 2017-01-14
- Stop
- 2017-01-14
The parties
- Patient
- patient Orville Everette Wiza
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Humana
Record id
0c0a7153-7cec-9b16-7850-451dc0bfd014