Claim total
$1,175.20
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2016-10-11
- Stop
- 2016-10-12
The parties
- Patient
- patient Caitlyn Elli Kuhlman
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer No insurance
Record id
0037332a-29d1-a298-7208-5b033528c7a9