Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-03-29
- Stop
- 2019-03-29
The parties
- Patient
- patient Florencio Jimmy DuBuque
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
350f34bd-fb57-b511-5cde-8413798e40c1