Claim total
$127.17
base $127.17 · payer covered $67.03
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2020-10-12
- Stop
- 2020-10-12
The parties
- Patient
- patient Raleigh Marlon Quitzon
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Medicaid
Record id
36d18d55-3a3e-3ebd-3478-cfba894b1d9d