Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2016-11-25
- Stop
- 2016-11-25
The parties
- Patient
- patient Lanita Daysi Jast
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Cigna Health
Record id
220bdd53-c919-6b71-40ca-92311878304c