Claim total
$538.47
base $127.17 · payer covered $488.47
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of knee125601008
- Start
- 2025-04-28
- Stop
- 2025-04-28
The parties
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
2f09b60e-f3e9-f8c5-8398-b6e0f70c2b90