Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2022-07-02
- Stop
- 2022-07-02
The parties
- Patient
- patient Brandon Riley Simonis
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
39c27234-b873-e34d-a379-15af0949a7c3