Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2026-05-02
- Stop
- 2026-05-02
The parties
- Patient
- patient Jackie Stevie Bruen
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
18105727-75f2-3289-f012-5957a816958d