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
- 2022-10-12
- Stop
- 2022-10-12
The parties
- Patient
- patient Benito César Quintero
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer No insurance
Record id
2474b3ff-db68-b836-d313-3d94cfa4762e