Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of neck90460009
- Start
- 2024-11-04
- Stop
- 2024-11-04
The parties
- Patient
- patient Rex Jules Denesik
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
06303127-1d9c-5fa8-6d76-df90558584ec