Claim total
$127.17
base $127.17 · payer covered $24.77
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2020-03-04
- Stop
- 2020-03-05
The parties
- Patient
- patient Guadalupe Shad Daniel
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
0a20b931-ad32-e940-5ca7-80785d9c578a