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
- 2019-10-31
- Stop
- 2019-10-31
The parties
- Patient
- patient Lauren Bennie Sanford
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Humana
Record id
369de274-8fc6-963d-33e4-0f42a35414d9