Claim total
$4,139.73
base $127.17 · payer covered $3,989.73
The visit
- Class
- Emergency
- Code
- 50849002
- Reason
- —
- Start
- 2025-01-11
- Stop
- 2025-01-11
The parties
- Patient
- patient America Bernita Cronin
- Provider
- provider Emerson Jast
- Care site
- care site SOUTHSIDE COMMUNITY CLINIC
- Payer
- payer Medicaid
Record id
0d047f1f-2497-6e70-348c-50120c39a4ef