Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2000-12-05
- Stop
- 2000-12-05
The parties
- Patient
- patient America Bernita Cronin
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0d047f1f-2497-6e70-a3c3-da93c3b4fbf7