Claim total
$4,094.85
base $127.17 · payer covered $4,044.85
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2016-07-09
- Stop
- 2016-07-09
The parties
- Patient
- patient Sharie Nikia Hegmann
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
00decd7e-554a-447f-3dd0-63eeb32c5c73