Claim total
$4,854.63
base $127.17 · payer covered $4,819.63
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2017-10-17
- Stop
- 2017-10-17
The parties
- Patient
- patient José Luis Esteban Palomo
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
2c5a4ef2-0007-8652-c0d6-4ffb63b5858d