Claim total
$1,148.04
base $127.17 · payer covered $918.43
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2024-05-22
- Stop
- 2024-05-22
The parties
- Patient
- patient Brenna Gricelda Lind
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
0291d14d-46f7-a76b-49dd-028a6ea56d89