Emergency room admission

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patient Anderson Humberto Prosacco
Emergency room admission

Claim total

$127.17

base $127.17 · payer covered $101.74

The visit

Class: Emergency
Code: 50849002
Reason: diagnosis concept Sprain384709000
Start: 2017-06-24
Stop: 2017-06-24

The parties

Patient: patient Anderson Humberto Prosacco
Provider: provider Elisabeth Smith
Care site: care site COVENANT LIVING OF GOLDEN VALLEY CARE & REHAB CTR
Payer: payer UnitedHealthcare

Record id 1ebab170-8a1d-2e20-3469-6100be262b84