Claim total
$1,039.56
base $127.17 · payer covered $831.64
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2024-06-19
- Stop
- 2024-06-19
The parties
- Patient
- patient Brenna Gricelda Lind
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
0291d14d-46f7-a76b-2e41-3eee6bf9e50c