Claim total
$127.17
base $127.17 · payer covered $0.00
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- diagnosis concept Sprain384709000
- Start
- 2025-12-16
- Stop
- 2025-12-16
The parties
- Patient
- patient August Israel Daugherty
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Aetna
Record id
0c069c15-b3e5-c713-6f5d-d21e2921353a