Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2023-09-19
- Stop
- 2023-09-19
The parties
- Patient
- patient Herminia Evelyn Tillman
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
10e50578-2bab-6f42-4fbc-dea6aa67a0b0