Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2020-09-25
- Stop
- 2020-09-25
The parties
- Patient
- patient Sarina Alisa Sanford
- Provider
- provider Jeremy Veum
- Care site
- care site THE VILLA AT BRYN MAWR
- Payer
- payer Medicaid
Record id
258adedd-a3fb-a6a3-e87a-933248a920ac