Claim total
$5,048.62
base $127.17 · payer covered $4,998.62
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 2007-12-25
- Stop
- 2007-12-25
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
00decd7e-554a-447f-0b6e-23f200f5a834