Claim total
$538.47
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of knee125601008
- Start
- 2022-01-21
- Stop
- 2022-01-21
The parties
- Patient
- patient Kaley Trena Schuppe
- Provider
- provider Ismael Botsford
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Aetna
Record id
0bb99e9f-e993-1284-fa05-d5341948f365