Claim total
$4,189.54
base $127.17 · payer covered $4,154.54
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Seizure disorder128613002
- Start
- 2010-07-21
- Stop
- 2010-07-21
The parties
- Patient
- patient Royce Peter Wolf
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Dual Eligible
Record id
04658673-6112-6940-4ef6-62a206849832