Claim total
$11,091.68
base $127.17 · payer covered $11,041.68
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2018-03-19
- Stop
- 2018-03-19
The parties
- Patient
- patient Karin Fredda Balistreri
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0f62f966-85f5-5e3e-ed4f-dcdf04b1fe96