Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2023-05-01
- Stop
- 2023-05-01
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-80c9-c0fb21ecd8e7