Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-06-20
- Stop
- 2019-06-20
The parties
- Patient
- patient Woodrow Ricardo Champlin
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Cigna Health
Record id
25dcb0bd-60e6-a38f-0fc4-e9e6af2f68dc