Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2022-04-15
- Stop
- 2022-04-16
The parties
- Patient
- patient Breanne Pennie Sawayn
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0db4a798-0c32-fd1c-75e0-5a91251929ac