Claim total
$12,255.33
base $127.17 · payer covered $12,205.33
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2024-01-04
- Stop
- 2024-01-04
The parties
- Patient
- patient Slyvia Natosha Zboncak
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0725e104-ee96-c3d4-38b0-9cfebd84bbe6