Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-06-24
- Stop
- 2025-06-25
The parties
- Patient
- patient Domonique Lelia Padberg
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Medicaid
Record id
1cc0cde3-5798-4cc6-6879-47a0bc32f2f9