Claim total
$127.17
base $127.17 · payer covered $53.94
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of neck90460009
- Start
- 2022-06-25
- Stop
- 2022-06-26
The parties
- Patient
- patient Dwain Colin Simonis
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0ed9a3cf-eb03-2b47-0d33-0b2d6ca75a1d