Claim total
$12,987.21
base $127.17 · payer covered $6,497.43
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Fracture of bone125605004
- Start
- 2022-03-03
- Stop
- 2022-03-03
The parties
- Patient
- patient Clara Rosalia Cantú
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Humana
Record id
0bbd45c6-8916-cb4f-cc44-18d4a57462bd