Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2017-08-17
- Stop
- 2017-08-17
The parties
- Patient
- patient Palma Roberts
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
0a378f33-73dc-7635-f2c4-8882e4b5205e