Claim total
$3,935.75
base $127.17 · payer covered $3,900.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2016-08-25
- Stop
- 2016-08-25
The parties
- Patient
- patient Terrell Allan Walter
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
0c1ee120-1dc7-6b68-9b7b-62161fb2a592