Claim total
$13,071.06
base $127.17 · payer covered $13,021.06
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 2022-01-06
- Stop
- 2022-01-06
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-3740-700f-ccfe48a156eb