Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2013-03-05
- Stop
- 2013-03-05
The parties
- Patient
- patient Preston Santos Lemke
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
256050e0-8358-3f97-1ae4-fd0c87370540