Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2007-08-28
- Stop
- 2007-08-29
The parties
- Patient
- patient Salome Kanisha D'Amore
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Dual Eligible
Record id
204f81a9-88e4-4fbf-3dfd-906a90d36c95