Claim total
$9,999.23
base $127.17 · payer covered $9,964.23
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2021-05-26
- Stop
- 2021-05-26
The parties
- Patient
- patient Kizzy Blondell Hermann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
0fa13c65-5aee-f679-765f-5abb7a8b1de4