Claim total
$5,615.87
base $127.17 · payer covered $5,565.87
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Laceration - injury312608009
- Start
- 2020-08-04
- Stop
- 2020-08-05
The parties
- Patient
- patient Cherri Mariette Brekke
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
08a12ee7-a852-94d4-3adc-cac377617241