Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2021-04-17
- Stop
- 2021-04-17
The parties
- Patient
- patient Alfonso Arnold Kautzer
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Medicaid
Record id
0798f71c-1ec2-447d-766e-dccb0af8bdfe