Claim total
$16,964.25
base $127.17 · payer covered $13,571.41
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2008-05-07
- Stop
- 2008-05-07
The parties
- Patient
- patient Yvonne Ondricka
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
2651fa10-73ce-522f-35b0-a5c5bacd7d9c