Claim total
$3,935.75
base $127.17 · payer covered $3,885.75
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2020-10-02
- Stop
- 2020-10-02
The parties
- Patient
- patient Emerald Katie Jerde
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
24d0e6e5-8a87-707b-3785-57a96bceb9c1