Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-07-21
- Stop
- 2025-07-21
The parties
- Patient
- patient Isiah Kurtis Connelly
- Provider
- provider Sau Wiegand
- Care site
- care site MVNA
- Payer
- payer Medicaid
Record id
3b24d024-a466-fe09-5659-88f002ba1ec0