Claim total
$728.31
base $127.17 · payer covered $678.31
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2017-05-31
- Stop
- 2017-06-01
The parties
- Patient
- patient Bess Mindy Boyer
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
03ef4f74-940b-d219-4ae4-c61bef698e05