Claim total
$15,361.54
base $127.17 · payer covered $5,674.76
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2025-12-16
- Stop
- 2025-12-16
The parties
- Patient
- patient Queenie Van Keebler
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
046b1f1e-c36f-c080-de7d-a4b126ca9258