Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-11-01
- Stop
- 2019-11-01
The parties
- Patient
- patient Sheldon Milan Koch
- Provider
- provider Raymond Ebert
- Care site
- care site CARONDELET VILLAGE CARE CENTER
- Payer
- payer Anthem
Record id
28fc4489-6f3e-4157-060f-4e2f57dc673b