Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2023-11-19
- Stop
- 2023-11-19
The parties
- Patient
- patient Justin Clemente Wiegand
- Provider
- provider Shellie Pacocha
- Care site
- care site MILS HOME HEALTH CARE AGENCY
- Payer
- payer Medicaid
Record id
1157d660-5b46-2e3c-1578-0dd92a30833d