Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Burn injury48333001
- Start
- 2021-06-14
- Stop
- 2021-06-14
The parties
- Patient
- patient Sabra Hermann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
20526ee7-17ba-b863-36f4-7059f012c746