Claim total
$12,882.34
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2023-08-04
- Stop
- 2023-08-04
The parties
- Patient
- patient Romeo Dennis Koelpin
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
2137817a-d236-724b-bdfc-d14b3611309a