Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2014-12-30
- Stop
- 2014-12-30
The parties
- Patient
- patient Zada Clair Kovacek
- Provider
- provider Claudia Bauch
- Care site
- care site THE VILLA AT ST LOUIS PARK
- Payer
- payer Dual Eligible
Record id
10c7f1c8-ab80-e90a-d62e-7aed11c96c9b