Claim total
$16,418.17
base $127.17 · payer covered $12,280.47
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-01-26
- Stop
- 2025-01-26
The parties
- Patient
- patient Joaquin Adalberto Wisoky
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Anthem
Record id
0cbeb834-403c-2bde-4425-dbbbfd26824e