Claim total
$4,189.54
base $127.17 · payer covered $4,139.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Seizure disorder128613002
- Start
- 2018-11-25
- Stop
- 2018-11-25
The parties
- Patient
- patient Barry Adam Heller
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
02680c28-26cc-4bca-0bae-6257a1a35bb1