Claim total
$15,361.54
base $127.17 · payer covered $15,326.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2016-11-07
- Stop
- 2016-11-07
The parties
- Patient
- patient Bob Sergio O'Hara
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
261c034c-cc44-5f0f-3944-79da6fcab574