Claim total
$4,252.58
base $76.30 · payer covered $4,202.58
The visit
- Class
- Emergency
- Code
- 185345009
- Reason
- diagnosis concept Acute infective cystitis307426000
- Start
- 2024-01-02
- Stop
- 2024-01-02
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
03d1ce86-efe3-018d-d6df-ae6b4d9578c2