Claim total
$3,935.75
base $127.17 · payer covered $1,809.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2017-01-26
- Stop
- 2017-01-26
The parties
- Patient
- patient Jan Cliff Johnson
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
Record id
085b5e58-fc26-ce3b-d8b5-a26b5c42288f