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
- 2021-10-15
- Stop
- 2021-10-15
The parties
- Patient
- patient Antonia George Gislason
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Humana
Record id
0dbf2ba6-39af-b055-57b7-105ec2bbd6cd