Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2018-01-19
- Stop
- 2018-01-19
The parties
- Patient
- patient Fausto Jermaine Rice
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
22582bf2-69a5-1fcf-ee5e-181e2bd15927