Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-08-28
- Stop
- 2019-08-28
The parties
- Patient
- patient Kizzy Blondell Hermann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
0fa13c65-5aee-f679-a4c8-edc9abffcf11