Claim total
$146.20
base $127.17 · payer covered $96.20
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 1994-10-09
- Stop
- 1994-10-09
The parties
- Patient
- patient Adrian Grady O'Keefe
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
00a9bdc8-6b4d-5df7-f6ea-60759c47c6ee