Claim total
$4,854.63
base $127.17 · payer covered $3,883.71
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2025-11-29
- Stop
- 2025-11-29
The parties
- Patient
- patient Cristy Exie Pouros
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicare
Record id
034e20ab-aae7-ddf8-ba1d-6afad59fadda