Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2017-06-06
- Stop
- 2017-06-06
The parties
- Patient
- patient Johnsie Jennie Sipes
- Provider
- provider Valeria Hoeger
- Care site
- care site PROVIDENCE PLACE
- Payer
- payer Medicaid
Record id
38947f55-f973-1892-614e-4aa7789b34e9