Claim total
$3,935.75
base $127.17 · payer covered $3,022.51
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2024-02-14
- Stop
- 2024-02-14
The parties
- Patient
- patient Kathey Ondricka
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Anthem
Record id
1e8bb4ba-36c4-2fd4-c796-096ca6636798