Claim total
$127.17
base $127.17 · payer covered $127.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2016-11-20
- Stop
- 2016-11-20
The parties
- Patient
- patient Wei Leoma Bartoletti
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
244d6b00-ebfa-1c46-a75e-ca952091dd51