Claim total
$127.17
base $127.17 · payer covered $127.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2022-05-19
- Stop
- 2022-05-19
The parties
- Patient
- patient Earle Fritsch
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
237ceca7-23fb-5ef0-37b9-828554078d06