Claim total
$127.17
base $127.17 · payer covered $101.74
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2001-04-03
- Stop
- 2001-04-03
The parties
- Patient
- patient Raylene Edris Parisian
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
298344b3-dd31-0e7f-6c96-863c0419d2d8