Claim total
$949.77
base $127.17 · payer covered $517.71
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2016-10-17
- Stop
- 2016-10-17
The parties
- Patient
- patient Margo Jene Beier
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer UnitedHealthcare
Record id
2acc43d9-4ea6-321e-5d89-1272f03f8572