Claim total
$7,476.81
base $127.17 · payer covered $7,326.81
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 2023-04-05
- Stop
- 2023-04-05
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-3740-3b17-53fd14bb8fea