Claim total
$5,190.27
base $127.17 · payer covered $5,140.27
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2023-04-20
- Stop
- 2023-04-20
The parties
- Patient
- patient Gita Pei Mraz
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
01d312ef-e970-710c-82c5-4d4baf4589cb