Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2026-06-22
- Stop
- 2026-06-22
The parties
- Patient
- patient Tia Ellan Hickle
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
2e005e83-bf8f-1b2f-555a-353b9023029a