Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-07-28
- Stop
- 2019-07-28
The parties
- Patient
- patient Josue Joaquin Nicolas
- Provider
- provider Davida Wolff
- Payer
- payer Medicaid
Record id
18b3ccbc-153b-4ee3-e73f-0dad08b8e574