Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2019-05-15
- Stop
- 2019-05-15
The parties
- Patient
- patient Brendon Marcos Sanford
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
032ec4eb-84a5-3e3f-b8b5-c174f1aaa592