Claim total
$538.47
base $127.17 · payer covered $430.78
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Injury of knee125601008
- Start
- 2026-08-29
- Stop
- 2026-08-29
The parties
- Patient
- patient Una Carmelita Douglas
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
391dd5d2-a7de-4280-284b-9833d1d45f5d