Claim total
$127.17
base $127.17 · payer covered $77.17
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Overdose1149222004
- Start
- 2021-11-14
- Stop
- 2021-11-14
The parties
- Patient
- patient Lee Scot Rosenbaum
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
027e2621-860b-6019-8836-8efc978d3013