Claim total
$127.17
base $127.17 · payer covered $92.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2016-08-30
- Stop
- 2016-08-30
The parties
- Patient
- patient Tisa Joya Stoltenberg
- Provider
- provider Sonny Zboncak
- Care site
- care site CREST VIEW LUTHERAN HOME
- Payer
- payer Dual Eligible
Record id
2debd169-2d62-f488-fee4-1e2bb98b55d8