Claim total
$13,059.39
base $127.17 · payer covered $13,024.39
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2022-01-20
- Stop
- 2022-01-20
The parties
- Patient
- patient Tamesha Lecia Wyman
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
391bc040-899c-a7be-a1d8-f524f22b5fb7