Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2024-03-04
- Stop
- 2024-03-04
The parties
- Patient
- patient Kaley Trena Schuppe
- Provider
- provider Ismael Botsford
- Care site
- care site WSCHS, INC - AGAPE CLINIC
- Payer
- payer Cigna Health
Record id
0bb99e9f-e993-1284-13bc-202a12900628