Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of neck90460009
- Start
- 2025-12-17
- Stop
- 2025-12-17
The parties
- Patient
- patient Mitch Trey Leannon
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
17228e98-12bd-8e80-2fca-c44b6ad8a3e2