Claim total
$8,057.89
base $127.17 · payer covered $7,981.79
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Impacted molars196416002
- Start
- 2018-06-07
- Stop
- 2018-06-07
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-3740-9a9b-f582e087244a