Claim total
$5,211.32
base $127.17 · payer covered $5,161.32
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 2017-09-28
- Stop
- 2017-09-28
The parties
- Patient
- patient Terrance Raymon Kuhic
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
03e733d5-721a-3740-0adf-372cb7fbe5a5