Claim total
$5,014.11
base $127.17 · payer covered $4,964.11
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2020-12-03
- Stop
- 2020-12-03
The parties
- Patient
- patient Dong Borer
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
06fe0fa1-aba9-b4f6-bfd9-eb735a436e48